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BACKGROUND: Knee osteoarthritis negatively affects the gait of patients, especially that of elderly people. However, the assessment of wearable sensors in knee osteoarthritis patients has been under-researched. During clinical assessments, patients may change their gait patterns under the placebo effect, whereas wearable sensors can be used in any environment. METHODS: Sixty patients with knee osteoarthritis and 20 control subjects were included in the study. Wearing shoes with an IMU sensor embedded in the insoles, the participants were required to walk along a walkway. The sensor data were collected during the gait. To discriminate between healthy and knee osteoarthritis patients and to classify different subgroups of knee osteoarthritis patients (patients scheduled for surgery vs. patients not scheduled for surgery; bilateral knee osteoarthritis diagnosis vs. unilateral knee osteoarthritis diagnosis), we used a machine learning approach called the support vector machine. A total of 88 features were extracted and used for classification. FINDINGS: The patients vs. healthy participants were classified with 71% accuracy, 85% sensitivity, and 56% specificity. The "patients scheduled for surgery" vs. "patients not scheduled for surgery" were classified with 83% accuracy, 83% sensitivity, and 81% specificity. The bilateral knee osteoarthritis diagnosis vs. unilateral knee osteoarthritis diagnosis was classified with 81% accuracy, 75% sensitivity, and 79% specificity. INTERPRETATION: Gait analysis using wearable sensors and machine learning can discriminate between healthy and knee osteoarthritis patients and classify different subgroups with reasonable accuracy, sensitivity, and specificity. The proposed approach requires no complex gait factors and is not limited to controlled laboratory settings.
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Marcha , Osteoartrite do Joelho , Sapatos , Humanos , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/classificação , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Análise da Marcha/métodos , Análise da Marcha/instrumentação , Dispositivos Eletrônicos Vestíveis , Aprendizado de Máquina , Máquina de Vetores de Suporte , Sensibilidade e Especificidade , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To compare scapular kinematics and muscle activity among various scapular muscle exercises. DESIGN: A cross-sectional study. SETTING: A university research laboratory. PARTICIPANTS: Eighteen healthy men participated in this study. MAIN OUTCOME MEASURES: Three-dimensional scapular kinematics was measured with an electromagnetic motion capture system. Activities of the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) were measured by using surface electromyography (EMG). In addition, the ratio of LT to the UT (LT/UT) and SA to the UT (SA/UT) was calculated. A repeated one-way analysis of variance and Shaffer's post-hoc analysis were used to detect the differences in each outcome during five exercises. RESULTS: The scapula was rotated upwardly during all exercises except push-up plus. The LT/UT ratio during side-lying external rotation and side-lying flexion were significantly higher than that for scapular plane elevation (P < .05), although the highest activity of the lower trapezius was produced during scapular plane elevation. The activities of the serratus anterior and SA/UT ratio during horizontal adducted elevation and push-up plus were significantly higher than that during scapular plane elevation (P < .05). CONCLUSION: Horizontal adducted elevation might be more appropriate for increasing scapular upward rotation with high serratus anterior activity and SA/UT ratio than push-up plus.
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Eletromiografia , Escápula , Músculos Superficiais do Dorso , Humanos , Masculino , Escápula/fisiologia , Fenômenos Biomecânicos/fisiologia , Estudos Transversais , Músculos Superficiais do Dorso/fisiologia , Adulto Jovem , Adulto , Músculo Esquelético/fisiologia , Amplitude de Movimento Articular/fisiologia , Exercício Físico/fisiologiaRESUMO
BACKGROUND: Reduced ankle quasi-joint stiffness affects propulsion in the paretic side of patients with hemiparesis, contributing to gait asymmetry. We investigated whether the use of an ankle-foot orthosis with dorsiflexion resistance to compensate for reduced stiffness would increase quasi-joint stiffness and spatiotemporal symmetry in patients with hemiparesis. METHODS: Seventeen patients walked along a 7-m walkway in both ankle-foot orthosis with dorsiflexion resistance and control (i.e., ankle-foot orthosis) conditions. Dorsiflexion resistance by spring and cam was set to increase linearly from zero-degree ankle dorsiflexion. Gait data were analyzed using a three-dimensional motion analysis system. FINDINGS: Ankle-foot orthosis with dorsiflexion resistance significantly increased the quasi-joint stiffness in the early and middle stance phase (P = 0.028 and 0.040). Furthermore, although ankle power generation in the ankle-foot orthosis with dorsiflexion resistance condition was significantly lower than in the control condition (P = 0.003), step length symmetry significantly increased in the ankle-foot orthosis with dorsiflexion resistance condition (P = 0.016). There was no significant difference in swing time ratio between conditions. INTERPRETATION: Applying dorsiflexion resistance in the paretic stance phase increased quasi-joint stiffness but did not lead to an increase in ankle power generation. On the other hand, applying dorsiflexion resistance also resulted in a more symmetrical step length, even though the ankle joint power generation on the paretic side did not increase as expected. Future research should explore whether modifying the magnitude and timing of dorsiflexion resistance, considering the biomechanical characteristics of each patients' ankle joint during gait, enhances ankle joint power generation.
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Articulação do Tornozelo , Órtoses do Pé , Marcha , Paresia , Humanos , Articulação do Tornozelo/fisiopatologia , Paresia/fisiopatologia , Paresia/reabilitação , Paresia/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/etiologia , Amplitude de Movimento Articular , Fenômenos Biomecânicos , AdultoRESUMO
BACKGROUND: Low-intensity continuous inspiratory muscle training improves its strength. The abdominal muscles are the main expiratory muscles, and their training may improve expiratory muscle strength. Respiratory muscle strength regulates coughing effectiveness, which is critical for pneumonia management. In older people, risk factors for the development of pneumonia were respiratory muscle weakness and swallowing impairment. Currently, the impact of high-intensity intermittent inspiratory and abdominal muscle combined training on the respiratory, swallowing, and systemic muscles is unclear. OBJECTIVE: We aimed to explore the effects of high-intensity inspiratory muscle training combined with or without abdominal muscle training on respiratory muscle strength as well as the strength, mass, and performance of swallowing and systemic muscles. METHODS: Twenty-eight healthy adults were divided into two groups. Participants performed high-intensity intermittent inspiratory muscle single or its combination with abdominal muscle training for 4 weeks. Respiratory muscle strength, swallowing muscle strength and mass, systemic muscle strength, mass and performance were measured at baseline, Week 2 and Week 4. RESULTS: Both groups showed greater maximal respiratory pressures at Week 2 and Week 4 than baseline. Both groups showed improved tongue pressure and geniohyoid muscle thickness at Week 4. In addition, the combined training group improved body trunk muscle mass, handgrip strength and five-time chair stand test, whereas the single training group did not. CONCLUSION: This study revealed that high-intensity inspiratory muscle training improved inspiratory muscle strength and swallowing muscle strength and mass. Moreover, inspiratory and abdominal muscle combined training showed an additional benefit of improving systemic muscle strength, mass and performance. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000046724; https://upload.umin.ac.jp/cgi-open-bin/ctr/index.cgi?ctrno=UMIN000046724.
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Músculos Abdominais , Exercícios Respiratórios , Deglutição , Voluntários Saudáveis , Força Muscular , Músculos Respiratórios , Humanos , Masculino , Feminino , Exercícios Respiratórios/métodos , Músculos Respiratórios/fisiologia , Força Muscular/fisiologia , Deglutição/fisiologia , Adulto , Músculos Abdominais/fisiologia , Inalação/fisiologia , Adulto Jovem , Força da Mão/fisiologiaRESUMO
The differences in kinetic mechanisms of decreased gait speed across brain lesion sides have not been elucidated, including the arrangement of motor modules reflected by kinetic interjoint coordination. The purpose of this study was to elucidate the differences in the kinetic factors of slow gait speed in patients with stroke on the lesion sides. A three-dimensional motion analysis system was employed to assess joint moment in the lower limb and representative gait parameters in 32 patients with right hemisphere brain damage (RHD) and 38 patients with left hemisphere brain damage (LHD) following stroke as well as 20 healthy controls. Motor module composition and timing were determined using principal component analysis based on the three joint moments in the lower limb in the stance phase, which were the variances accounted for principal components (PCs) and the peak timing in the time series of PCs. A stepwise multiple linear regression analysis was performed to identify the most significant joint moment and PC-associated parameter in explaining gait speed. A negligible difference was observed in age, weight, height, and gait speed among patients with RHD and LHD and controls. The following factors contributed to gait speed: in patients with RHD, larger ankle plantarflexion moment on the paretic (p = 0.001) and nonparetic (p = 0.002) sides and ankle dorsiflexion moment on the nonparetic side (p = 0.004); in patients with LHD, larger ankle plantarflexion moment (p < 0.001) and delayed peak timing of the first PC (p = 0.012) on the paretic side as well as ankle dorsiflexion moment on the nonparetic side (p < 0.001); in the controls, delayed peak timing of the first PC (p = 0.002) on the right side and larger ankle dorsiflexion moment (p = 0.001) as well as larger hip flexion moment on the left side (p = 0.023). The findings suggest that the kinetic mechanisms of gait speed may differ among patients with RHD following patients with stroke with LHD, and controls.
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BACKGROUND: Stroke often induces gait abnormality, such as buckling knee pattern, compromising walking ability. Previous studies indicated that an adequate trailing limb angle (TLA) is critical for recovering walking ability. OBJECTIVE: We hypothesized that correcting gait abnormality by immobilizing the knee joint using a knee orthosis (KO) would improve walking patterns and increase the TLA, and investigated whether walking training using a KO would increase the TLA in post-stroke patients. METHODS: In a randomized controlled trial, thirty-four participants were assigned to KO (walking training using a KO) and non-KO (without using a KO) groups. Twenty-nine completed the three-week gait training protocol. TLA was measured at baseline and after training. A two-way repeated ANOVA was performed to evaluate TLA increases with training type and time as test factors. A t-test compared TLA changes (ΔTLA) between the two groups. RESULTS: ANOVA showed a main effect for time (Fâ=â64.5, pâ<â0.01) and interaction (Fâ=â15.4, pâ<â0.01). ΔTLA was significantly higher in the KO group (14.6±5.8) than in the non-KO group (5.0±7.0, pâ<â0.001). CONCLUSION: Walking training using a KO may be practical and effective for increasing TLA in post-stroke patients.
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Hemiplegia , Aparelhos Ortopédicos , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hemiplegia/reabilitação , Hemiplegia/etiologia , Idoso , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Transtornos Neurológicos da Marcha/reabilitação , Transtornos Neurológicos da Marcha/etiologia , Caminhada/fisiologia , Articulação do Joelho/fisiopatologia , Adulto , Resultado do Tratamento , Fenômenos BiomecânicosRESUMO
BACKGROUND: An inertial measurement unit is small and lightweight, allowing patient measurements without physical constraints. This study aimed to determine the differences in kinematic parameters during gait using an insole with a single inertial measurement unit in healthy controls and on both sides in patients with knee osteoarthritis. METHODS: Twenty patients with knee osteoarthritis and 13 age-matched controls were included in this study. The participants walked at a self-selected speed and foot kinematics were measured during gait using an insole with a single inertial measurement unit. The right side of the healthy controls and both the affected and contralateral sides of patients with KOA were analyzed separately. FINDINGS: The foot extension angular velocity at toe-off was significantly reduced on the affected side than on the contralateral side (P < 0.001) and in healthy controls (P < 0.001). During the swing phase, foot posterior-anterior acceleration was significantly lower on the affected side than on the healthy controls (P = 0.005). Furthermore, despite a decrease in walking speed, foot superior-inferior acceleration at initial contact in patients was significantly lower on the contralateral side than in healthy controls (P = 0.0167), but not on the affected side (P = 0.344). INTERPRETATION: An insole with a single inertial measurement unit can detect differences in foot kinematics during gait between healthy controls and patients with knee osteoarthritis. Our findings indicate that patients with knee osteoarthritis exhibit dysfunction of push-off at toe-off and shock absorption at initial contact on the affected side.
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Osteoartrite do Joelho , Humanos , Articulação do Joelho , Fenômenos Biomecânicos , Estudos de Casos e Controles , Marcha , CaminhadaRESUMO
The scientific evidence based on experiences with past disasters points to the possibility of the occurrence of future mental health issues among those who were affected by the recent Turkey-Syria earthquake. However, post-disaster care information on factors that could give rise to mental health issues among those affected have yet to be provided. In March 2011, Tohoku University compiled and published a booklet with post-disaster healthcare information based on the experiences with the Great East Japan Earthquake. This study aimed to promote the introduction and use of this booklet for post-disaster care in Turkey and Syria by presenting the results of a satisfaction survey conducted with relevant Japanese organizations about the booklet. A total of 505 Japanese organizations participated in the satisfaction survey of, and evaluated, the booklet. The results indicated the need to consider the ease of understanding for the general public when providing information on post-disaster care through booklets. We hope that this study leads to the appropriate provision of easy-to-understand, post-disaster healthcare information to the victims of the Turkey-Syria earthquake and future disasters.
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Desastres , Terremotos , Humanos , Folhetos , Síria , Turquia , Necessidades e Demandas de Serviços de Saúde , JapãoRESUMO
The respiratory muscle force determines the intensity of cough force. A greater cough force for cleaning the airways is essential for preventing and managing pneumonia. Body posture can affect the onset of aspiration pneumonia. However, the effects of body posture on the respiratory muscle and cough forces remain unclear. Thus, we aimed to explore the influence of the four body postures on respiratory muscle force, cough pressure, subjective ease of coughing, and pulmonary function in healthy individuals. Twenty healthy individuals were included in this study. Body postures were 0-degree supine, 30- and 60-degree semi-recumbent, and 90-degree sitting. The maximal inspiratory and expiratory pressures, maximal cough pressure, subjective ease of coughing, and pulmonary function, including peak expiratory flow, were evaluated. We set the measured values in the supine posture to 100% and showed the relative values. The 60-degree posture showed stronger inspiratory (125.1 ± 3.9%, mean ± standard error [SE]) and expiratory (116.4 ± 3.0%) muscle force, cough pressure, more subjective ease of coughing, and greater peak expiratory flow (113.4 ± 3.0%) than the supine posture. The sitting posture also showed greater inspiratory muscle force and peak expiratory flow than the supine posture. The correlation coefficient for the 60-degree posture showed that the maximal inspiratory pressure was moderately correlated with the maximal expiratory pressure (r = 0.512), cough pressure (r = 0.495), and peak expiratory flow (r = 0.558). The above findings suggest the advantage of keeping a 60-degree posture and avoiding the supine posture to generate a greater cough force in the prevention and management of pneumonia.
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Pneumonia , Músculos Respiratórios , Humanos , Músculos Respiratórios/fisiologia , Respiração , Postura/fisiologia , TosseRESUMO
Patients with lateral epicondylalgia (LE) show alterations in the primary motor cortex (M1) contralateral to the affected side. Cortical alterations have been investigated by measuring intracortical facilitation/inhibition; however, their association with pain remains controversial. Furthermore, no studies have investigated changes in interhemispheric inhibition (IHI). IHI can be assessed using the ipsilateral silent period (iSP) known as the temporary inhibition of electromyographic activity evoked by transcranial magnetic stimulation in the ipsilateral M1 of the contracting muscle. To better understand the relationship between cortical alterations and pain in LE, this observational study investigated the relationship between iSP and pain in LE. Twenty-seven healthy volunteers and 21 patients with LE were recruited. The duration of iSP in the extensor carpi radialis brevis was measured. The IHI asymmetry ratio was calculated to determine the IHI balance. Pain and disability were scored using the Japanese version of the patient-rated elbow evaluation. We observed increased inhibitory input from the ipsilateral M1 on the affected side to the contralateral M1 in LE. Additionally, the IHI balance correlated with pain severity. Hence, regulating imbalanced IHI can potentially decrease lateral elbow pain in LE. PERSPECTIVE: Patients with lateral epicondylalgia (LE) experience persistent pain and cortical alterations. However, there is no established relationship between cortical alterations and pain. This study demonstrated that the interhemispheric inhibition (IHI) balance is correlated with pain. Regulating imbalanced IHI can potentially decrease lateral elbow pain in patients with LE.
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Tian D, Izumi S. TMS and neocortical neurons: an integrative review on the micro-macro connection in neuroplasticity. Jpn J Compr Rehabil Sci 2023; 14: 1-9. Neuroplasticity plays a pivotal role in neuroscience and neurorehabilitation as it bridges the organization and reorganization properties of the brain. Among the numerous neuroplastic protocols, transcranial magnetic stimulation (TMS) is a well-established non-invasive protocol to induce plastic changes in the brain. Here, we review the findings of four plasticity-inducing TMS protocols in the human motor cortex with relatively evident mechanisms: conventional repetitive TMS (rTMS), theta-burst stimulation (TBS), quadripulse stimulation (QPS) and paired associative stimulation (PAS). Based on the reviewed evidence and a preliminary TMS neurocytological model proposed in our previous report, we further integrate the neurophysiological evidence and plasticity rules of these protocols to present an updated micro-macro connection model between neocortical neurons and the neurophysiological evidence in TMS. This prototypical model will guide further efforts to understand the neural circuit of the motor cortex, the mechanisms of TMS, and the advance of neuroplasticity technologies and their outcomes.
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The use of neurofeedback is an important aspect of effective motor rehabilitation as it offers real-time sensory information to promote neuroplasticity. However, there is still limited knowledge about how the brain's functional networks reorganize in response to such feedback. To address this gap, this study investigates the reorganization of the brain network during motor imagery tasks when subject to visual stimulation or visual-electrotactile stimulation feedback. This study can provide healthcare professionals with a deeper understanding of the changes in the brain network and help develop successful treatment approaches for brain-computer interface-based motor rehabilitation applications. We examine individual edges, nodes, and the entire network, and use the minimum spanning tree algorithm to construct a brain network representation using a functional connectivity matrix. Furthermore, graph analysis is used to detect significant features in the brain network that might arise in response to the feedback. Additionally, we investigate the power distribution of brain activation patterns using power spectral analysis and evaluate the motor imagery performance based on the classification accuracy. The results showed that the visual and visual-electrotactile stimulation feedback induced subject-specific changes in brain activation patterns and network reorganization in the [Formula: see text] band. Thus, the visual-electrotactile stimulation feedback significantly improved the integration of information flow between brain regions associated with motor-related commands and higher-level cognitive functions, while reducing cognitive workload in the sensory areas of the brain and promoting positive emotions. Despite these promising results, neither neurofeedback modality resulted in a significant improvement in classification accuracy, compared with the absence of feedback. These findings indicate that multimodal neurofeedback can modulate imagery-mediated rehabilitation by enhancing motor-cognitive communication and reducing cognitive effort. In future interventions, incorporating this technique to ease cognitive demands for participants could be crucial for maintaining their motivation to engage in rehabilitation.
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Imaginação , Neurorretroalimentação , Humanos , Retroalimentação , Estimulação Luminosa , Imaginação/fisiologia , Encéfalo/fisiologia , Imagens, Psicoterapia , Neurorretroalimentação/métodos , EletroencefalografiaRESUMO
Effective treatments for stroke after the acute phase remain elusive. Muse cells are endogenous, pluripotent, immune-privileged stem cells capable of selectively homing to damaged tissue after intravenous injection and replacing damaged/lost cells via differentiation. This randomized, double-blind, placebo-controlled trial enrolled ischemic stroke patients with modified Rankin Scale (mRS) ≥3. Randomized patients received a single intravenous injection of an allogenic Muse cell-based product, CL2020 (n = 25), or placebo (n = 10), without immunosuppressant, 14-28 days after stroke onset. Safety (primary endpoint: week 12) and efficacy (mRS, other stroke-specific measures) were assessed up to 52 weeks. Key efficacy endpoint was response rate (percentage of patients with mRS ≤2 at week 12). To week 12, 96% of patients in the CL2020 group experienced adverse events and 28% experienced adverse reactions (including one Grade 4 status epilepticus), compared with 100% and 10%, respectively, in the placebo group. Response rate was 40.0% (95% CI, 21.1-61.3) in the CL2020 group and 10.0% (0.3-44.5) in the placebo group; the lower CI in the CL2020 group exceeded the preset efficacy threshold (8.7% from registry data). This randomized placebo-controlled trial demonstrated CL2020 is a possible effective treatment for subacute ischemic stroke.Registry information: JAPIC Clinical Trials Information site (JapicCTI-184103, URL: https://www.clinicaltrials.jp/cti-user/trial/ShowDirect.jsp?japicId=JapicCTI-184103).
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Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Alprostadil/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Método Duplo-Cego , Resultado do Tratamento , Isquemia Encefálica/tratamento farmacológicoRESUMO
The sense of body ownership, the feeling that one's body belongs to oneself, is a crucial subjective conscious experience of one's body. Recent methodological advances regarding crossmodal illusions have provided novel insights into how multisensory interactions shape human perception and cognition, underpinning conscious experience, particularly alteration of body ownership. Moreover, in post-stroke rehabilitation, encouraging the use of the paretic limb in daily life is considered vital, as a settled sense of ownership and attentional engagement toward the paralyzed body part may promote increased frequency of its use and prevent learned nonuse. Therefore, in addition to traditional methods, novel interventions using neurorehabilitation techniques that induce self-body recognition are needed. This study investigated whether the illusory experience of a patient's ownership alterations of their paretic hand facilitates the enhancement in the range of motion of succeeding imitation movements. An experiment combining a modified version of the rubber hand illusion with imitation training was conducted with chronic hemiplegia. A larger imitation movement of the paretic hand was observed in the illusion-induced condition, indicating that the feeling of ownership toward the observed limb promotes the induction of intrinsic potential for motor performance. This training, using subjective experience, may help develop new post-stroke rehabilitation interventions.
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Ilusões , Percepção do Tato , Humanos , Hemiplegia , Propriedade , Movimento , Mãos , Imagem Corporal , Percepção Visual , PropriocepçãoRESUMO
BACKGROUND: Body positions affect swallowing and gastroesophageal reflux. Swallowing impairment is one of the main causes of aspiration pneumonia. To prevent pneumonia, evaluation of body positions on gastroesophageal reflux recommended 30 degrees or higher semi-recumbent positions. The geniohypoid muscle and tongue play central roles in swallowing. However, the effects of body positions on contracting rates in the geniohyoid muscle and tongue pressure are unclear. Moreover, correlations between geniohyoid muscle contracting rates and subjective swallowing difficulties are unclear. AIMS: This study aimed to identify the proper body positions on contracting rates in the geniohyoid muscle, tongue pressure, and subjective swallowing difficulties. MATERIALS & METHODS: Twenty healthy adults swallowed 15- or 50 ml of water at 90 degrees sitting, 60- and 30 degrees semi-recumbent, and 0 degrees supine positions. We scored the subjective swallowing difficulties and measured the tongue pressure and the number of swallows. An ultrasound evaluated the geniohyoid muscle size and contracting rates. RESULTS: At sitting and 60 degrees semi-recumbent positions, the geniohyoid muscle showed greter contracting rates than at 30 degrees semi-recumbent and supine postions (P < 0.05), which resulted in easier swalloiwng. Greater tongue pressure was weakly correlated with fewer swallows (r = -0.339, P = 0.002), whereas the body positions did not affect. CONCLUSION: Considering swallowing and gastroesophageal reflux together, a trunk angle of 60 degrees or more might be beneficial for reducing the risk of aspiration.
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Deglutição , Refluxo Gastroesofágico , Humanos , Adulto , Deglutição/fisiologia , Pressão , Língua/fisiologia , Contração MuscularRESUMO
Background: Activity of the neural circuits in the human motor cortex can be probed using transcranial magnetic stimulation (TMS). Changing TMS-induced current direction recruits different cortical neural circuits. I-wave periodicity repetitive TMS (iTMS) substantially modulates motor cortex excitability through neural plasticity, yet its effect on interhemispheric interaction remains unclear. Objective: To explore the modulation of interhemispheric interaction by iTMS applied in different current directions. Materials and Methods: Twenty right-handed healthy young volunteers (aged 27.5 ± 5.0 years) participated in this study with three visits. On each visit, iTMS in posterior-anterior/anterior-posterior direction (PA-/AP-iTMS) or sham-iTMS was applied to the right hemisphere, with corticospinal excitability and intracortical facilitation of the non-stimulated left hemisphere evaluated at four timepoints. Ipsilateral silent period was also measured at each timepoint probing interhemispheric inhibition (IHI). Results: PA- and AP-iTMS potentiated cortical excitability concurrently in the stimulated right hemisphere. Corticospinal excitability of the non-stimulated left hemisphere increased 10 min after both PA- and AP-iTMS intervention, with a decrease in short-interval intracortical facilitation (SICF) observed in AP-iTMS only. Immediately after the intervention, PA-iTMS tilted the IHI balance toward inhibiting the non-stimulated hemisphere, while AP-iTMS shifted the balance toward the opposite direction. Conclusions: Our findings provide systematic evidence on the plastic modulation of interhemispheric interaction by PA- and AP-iTMS. We show that iTMS induces an interhemispheric facilitatory effect, and that PA- and AP-iTMS differs in modulating interhemispheric inhibition.
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Inflammatory pleuritis often causes pleural effusions, which are drained through lymphatic vessels (lymphatics) in the parietal pleura. The distribution of button- and zipper-like endothelial junctions can identify the subtypes of lymphatics, the initial, pre-collecting, and collecting lymphatics. Vascular endothelial growth factor receptor (VEGFR)-3 and its ligands VEGF-C/D are crucial lymphangiogenic factors. Currently, in the pleura covering the chest walls, the anatomy of the lymphatics and connecting networks of blood vessels are incompletely understood. Moreover, their pathological and functional plasticity under inflammation and the effects of VEGFR inhibition are unclear. This study aimed to learn the above-unanswered questions and immunostained mouse chest walls as whole-mount specimens. Confocal microscopic images and their 3-dimensional reconstruction analyzed the vasculatures. Repeated intra-pleural cavity lipopolysaccharide challenge induced pleuritis, which was also treated with VEGFR inhibition. Levels of vascular-related factors were evaluated by quantitative real-time polymerase chain reaction. We observed the initial lymphatics in the intercostals, collecting lymphatics under the ribs, and pre-collecting lymphatics connecting both. Arteries branched into capillaries and gathered into veins from the cranial to the caudal side. Lymphatics and blood vessels were in different layers with an adjacent distribution of the lymphatic layer to the pleural cavity. Inflammatory pleuritis elevated expression levels of VEGF-C/D and angiopoietin-2, induced lymphangiogenesis and blood vessel remodeling, and disorganized the lymphatic structures and subtypes. The disorganized lymphatics showed large sheet-like structures with many branches and holes inside. Such lymphatics were abundant in zipper-like endothelial junctions with some button-like junctions. The blood vessels were tortuous and had various diameters and complex networks. Stratified layers of lymphatics and blood vessels were disorganized, with impaired drainage function. VEGFR inhibition partially maintained their structures and drainage function. These findings demonstrate anatomy and pathological changes of the vasculatures in the parietal pleura and their potential as a novel therapeutic target.
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Vasos Linfáticos , Pleurisia , Camundongos , Animais , Pleura/metabolismo , Fator C de Crescimento do Endotélio Vascular/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Vasos Linfáticos/metabolismo , Linfangiogênese , Receptor 3 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Receptores de Fatores de Crescimento do Endotélio Vascular/metabolismo , Inflamação/metabolismo , Pleurisia/metabolismo , Pleurisia/patologiaRESUMO
Impaired % predicted value forced vital capacity (% FVC) is related to higher all-cause mortality in aged adults, and strong muscle force may improve this relationship. A muscle disease, sarcopenia, causes higher mortality. We aimed to identify the unknown disease that relates impaired % FVC with higher mortality in aged adults among the three major leading causes of death, and the effect of strong leg force on this relationship. Cox proportional hazard model analyzed the longitudinal Tsurugaya cohort that registered 1048 aged Japanese for 11 years. The primary outcome was the relationship between % FVC and mortality by cancer, cardiovascular disease, or pneumonia. Exposure variables were % FVC or leg force divided by 80% or median values, respectively. The secondary outcome was the effects of leg force on the relationship. Among the diseases, % FVC < 80% was related only to higher pneumonia mortality (hazard ratio [HR], 4.09; 95% CI, 1.90-8.83) relative to the % FVC ≥ 80% group before adjustment. Adding the leg force as an explanatory variable reduced the HR to 3.34 (1.54-7.25). Weak leg force might indicate sarcopenia, and its prevention may improve higher pneumonia mortality risk related to impaired % FVC, which we may advise people in clinical settings.
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Wearing loose footwear, such as slippers, poses a risk factor for tripping. Previous studies have examined obstacle crossing to find strategies to avoid tripping. However, the effect of wearing slippers on the likelihood of tripping remains unclear. Therefore, this study aimed to determine whether wearing slippers while level walking and obstacle crossing affects kinematic characteristics and muscle activity. Sixteen healthy, young adults performed two tasks (a) while wearing slippers and (b) while barefoot: (1) level walking and (2) crossing a 10-cm obstacle. Toe clearance, joint angles, muscle activity, and cocontraction were measured for both the leading and trailing lower limbs. In the slipper-wearing condition, knee flexion and hip flexion angles were significantly increased in the swing phase for the leading limb (p < .001 and p < .001, respectively) and trailing limb (p < .001 and p = .004, respectively) compared with the barefoot condition. Tibialis anterior activity (p = .01) and muscle cocontraction of the tibialis anterior and the medial head of the gastrocnemius (p = .047) were significantly increased in the swing phase of the trailing limb for the slipper-wearing condition compared with the barefoot condition in the obstacle crossing task. Wearing slippers increased knee and hip flexion angles, and muscle cocontraction of the tibialis anterior and medial head of gastrocnemius increased during obstacle crossing. The results revealed that obstacle crossing while wearing slippers would require foot fixation adjustment in addition to increased knee and hip flexion to avoid toe collision.
Assuntos
Extremidade Inferior , Caminhada , Humanos , Adulto Jovem , Caminhada/fisiologia , Pé , Articulação do Joelho/fisiologia , Dedos do Pé , Fenômenos Biomecânicos , Marcha/fisiologiaRESUMO
This study aimed to determine the relationship between skeletal muscle mass in an aged population with limited oral intake upon admission and functional oral intake at the subsequent 3-month follow-up. Methods: This was a retrospective cohort study using the Japanese Sarcopenia Dysphagia Database involving older adults (≥60 years) with limited oral intake (Food Intake Level Scale [FILS] level of ≤8). People without skeletal muscle mass index (SMI) data, unknown methods of SMI evaluation, and SMI evaluation by DXA were excluded. Data for 76 people (47 women, 29 men) were analyzed (mean [standard deviation] age: 80.8 [9.0] years; median SMI: women, 4.80 kg/m2; men, 6.50 kg/m2). There were no significant differences in age, FILS upon admission and methods of nutrition intake between the low (n = 46) and the high skeletal muscle mass groups (n = 30), although the proportion of sex between the two groups was different. The FILS level at the time of follow-up differed significantly between the groups (p < 0.01). The SMI upon admission (odds ratio: 2.99, 95% confidence interval: 1.09-8.16) were significantly associated with the FILS level at the time of follow-up after adjustment for sex, age, and history of stroke and/or dementia (p < 0.05, power = 0.756). Conclusion: A low skeletal muscle mass is a disadvantage for achieving a subsequent fully functional oral intake ability among the aged population with limited oral intake upon admission.