The acute effect of dopamine infusion on lipid and cytokine concentrations in persons with a cervical spinal cord injury-a pilot study.

STUDY DESIGN: Acute experimental study. OBJECTIVES: To investigate the acute response of markers of lipid metabolism and interleukin (IL)-6 to dopamine infusion in people with a cervical spinal cord injury (CSCI). SETTING: Laboratory of Wakayama Medical University, Japan. METHODS: Ten participants, four with CSCI and six AB individuals, underwent 50 min of dopamine infusion. Blood samples were collected prior to, immediately after and 1 h following cessation of dopamine infusion for the determination of circulating catecholamine, lipid, ketone body and IL-6 concentrations. RESULTS: The adrenaline concentration following dopamine infusion was increased by 59 ± 7% in CSCI (p = 0.038, Cohen's d effect size (ES): 1.47), while this was not changed in AB (p = 0.223). Triglycerides and acetoacetic acid concentration were increased in both groups, immediately after and 1 h post-infusion (triglycerides p ≤ 0.042, ES CSCI: 1.00, ES AB: 1.12; acetoacetic acid p ≤ 0.030; ES CSCI: 1.72, ES AB: 1.31). 3-Hydroxybutyric acid concentration was increased in CSCI only (48 ± 15%, p = 0.039, ES: 1.44; AB p = 0.115). Dopamine infusion did not affect plasma IL-6 concentration in either group (p ≥ 0.368). CONCLUSIONS: Dopamine infusion induced a sustained increase in triglyceride and ketone body concentrations in persons with CSCI. In contrast, cytokine concentrations were not affected by dopamine infusion. These findings suggest that circulating catecholamines can stimulate metabolism in people with CSCI despite the presence of autonomic dysfunction.

Fournier's Gangrene in a Patient with Type 2 Diabetes Mellitus Treated with Empagliflozin: A Case Report.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been reported as possibly associated with Fournier's gangrene (FG). This case report describes a 34-year-old Japanese man who was diagnosed with FG after the administration of empagliflozin for type 2 diabetes mellitus (T2DM). He presented with pain and swelling in the perineum and groin 142 days after initiating empagliflozin. The clinical features, laboratory data, and computed tomographic findings were consistent with FG. Surgical drainage and debridement of necrotic tissues were performed immediately after admission to our hospital. The patient had no complications of diabetes before the onset of FG. Glycemic management was good at the time of FG onset. This case suggests a possible association between empagliflozin and FG. We report a case of FG in a patient during a period of good glycemic management following treatment with empagliflozin. We recommend further awareness of this relationship and suggest the need for additional research.

Short and long-term effects of exergaming for the elderly.

OBJECTIVE: Exergaming has been introduced in safe and beneficial intervention for the elderly. However, no study has examined exergaming-based interventions for the elderly that last several years. Therefore, we investigated the effectiveness and safety of a 12-week intervention using step training with exergaming for the elderly (12-week study). Moreover, we conducted an exergaming-based intervention for 3 years (3-year study). MATERIALS AND METHODS: 12-week study: Forty-two elderly persons participated in this study. Using an in-house developed exergaming protocol, a step training was performed for 15 min/session twice a week for 12 weeks. We investigated post-intervention changes in motor functions, successful step-rate, the intensity of exercise, which was evaluated using Borg scale (Rating of Perceived Exertion). 3-year study: An intervention using exergaming was conducted for 12 weeks by 20 elderly participants. Two courses/year of exercise were performed at 3-month intervals. This was continued for 3 years. The exercise continuation rate, its influence on motor functions were investigated. RESULTS: 12-week study: Lower-limb muscle strength, balancing capacity, and whole body reaction time significantly improved in the exercise group. The mean score on Borg scale was 12 ± 2 on the first day of the step exercise and 9 ± 2 on the final day. 3-year study: Exercise was continued in 16 out of the 20 subjects. The Timed Up and Go Test, duration of one-footed standing, and quadriceps strength significantly improved. CONCLUSION: The results of the present study showed that exergaming provided an appropriate exercise intensity for the elderly and safely improved motor functions. The exercise continuation rate in the 3-year study was high. Improvements in motor functions may contribute to the prevention of falls.

Effects of two different intensities of transcutaneous electrical nerve stimulation on pain thresholds of contralateral muscles in healthy subjects.

[Purpose] This study aimed to investigate the differential effects of high-intensity and low-intensity transcutaneous electrical nerve stimulation on the contralateral side on the pain threshold in healthy subjects. [Subjects and Methods] Twenty-five healthy adults, volunteers received two intensity levels (motor-level, 1.5 times the muscle motor threshold; sensory-level, sensory threshold of the common peroneal nerve), for 30 s on separate days. Pressure pain threshold was recorded on the contralateral tibialis anterior and deltoid muscle before, during, and after stimulation. [Results] Motor-level stimulation significantly increased the pressure pain threshold at both muscle sites, while effects of sensory-level stimulation on pressure pain thresholds were significant only at the deltoid site. The percent change in pressure pain thresholds at both sites was significantly higher during motor-level stimulation. [Conclusion] Motor-level stimulation, applied unilaterally to one leg, produced immediate contralateral diffuse and segmental analgesic effects. This may be of therapeutic benefit in patients for whom transcutaneous electrical nerve stimulation cannot be directly used at the painful site.

A cross-sectional assessment of oxidative DNA damage and muscle strength among elderly people living in the community.

OBJECTIVES: The mechanism by which muscle weakness leads to an increased risk of death remains a subject of interest. In this context, the aim of this study is to assess the relationship between urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and muscle strength, and other risk factors contributing to poor muscle strength in older persons. METHODS: This was a cross-sectional study in which a total of 86 participants, both men and women, aged 65 years or above were screened for urinary 8-OHdG, and muscle strength as measured by handgrip strength. RESULTS: Handgrip strength was lower in participants who had history of acute or chronic disease. Urinary 8-OHdG level was negatively associated with muscle strength, and the association remained after adjusting for confounding factors. CONCLUSIONS: Urinary 8-OHdG is associated with muscle strength. These findings may be clinically relevant as there is a possibility of controlling oxidative DNA damage by healthy behaviors related to lifestyle.

Trunk deformity is associated with a reduction in outdoor activities of daily living and life satisfaction in community-dwelling older people.

We have evaluated the association between trunk deformities of the sagittal plane and functional impairment of daily living in community-dwelling elderly subjects. The analysis involved a detailed assessment of indoor and outdoor activities of daily living, satisfaction with life, and mental status. The participants in this study were 236 community-dwelling older adults, aged 65 years and older, living in Kahoku district of Kochi in Japan. The participants were classified based on their posture, which was assessed using photographs of the subjects, and interviewed to assess their basic activities of daily living (BADL), instrumental ADL (IADL), and cognitive well-being in the cross-sectional study. The statistical analysis was performed using the Mann-Whitney U-test. The lumbar kyphosis group received significantly lower BADL and IADL scores than the normal group. The trunk deformity group which were defined as kyphosis, flat back, and lumbar lordosis groups exhibited decreases in activities that included going out, shopping, depositing and withdrawing money, and visiting friends in the hospital. These activities require going outdoors; thus, this study showed that the trunk deformity group had limitations in outdoor activities. There was no significant difference between the geriatric depression score (GDS) and the pattern of posture. The abnormal trunk deformity groups tended to score lower than the normal group with regard to subjective healthiness and life satisfaction measures, including subjective health condition, everyday feeling, satisfaction with human relationships, satisfaction with economic condition, and satisfaction with present life.

Vertical ground reaction force shape is associated with gait parameters, timed up and go, and functional reach in elderly females.

OBJECTIVE: The aim of this study was to evaluate the relationship between knee pain and various indicators of the combined performance of the lower extremity (including gait parameters, functional performance such as timed up and go, and functional reach test) and to determine whether the classification of vertical ground reaction forces correlates with gait parameters and functional performance. SUBJECTS AND METHODS: Simultaneous analysis of gait, time-distance parameters and vertical ground reaction force. Timed up and go, and functional reach test were examined in 130 elderly women. The vertical component of the ground reaction force was grouped into 2 categories: M-shaped and non-M-shaped. RESULTS: No significant association was found between knee pain and timed up and go, functional reach test, or gait parameters in elderly female participants. There were significant differences between subjects with M- and non-M-shaped vertical ground reaction forces with regard to timed up and go, functional reach test and Japan Orthopaedic Association score. There were also significant differences between the 2 groups (M shaped and non-M-shaped) in gait parameters. CONCLUSION: Evaluation of the vertical ground reaction force to determine its shape may be a useful and simple tool in the analysis of gait and functional performance.

Posture of the trunk in the sagittal plane is associated with gait in community-dwelling elderly population.

OBJECTIVES: The purpose of this study was to evaluate whether abnormal posture of the trunk in the sagittal plane would affect gait and functional performance in the elderly. BACKGROUND: There have been very few reports on whether posture of the trunk is related to gait and functional performance. METHODS: The study group included 237 participants with a mean age of 80.0 years (range 65-94 years). The posture of the trunk in a standing position of the sagittal plane was classified into five groups. We investigated the relationship between the trunk posture in the sagittal plane and age with gait parameters and functional performance such as timed up & go test and functional reach. RESULTS: In the elderly subjects of normal posture, there was no difference between those in the 65-79 years age group and those in the 80 years and older age group in terms of any gait parameters. Walking abilities were significantly decreased in the abnormal posture groups. Among the abnormal posture groups, elderly in the lumbar kyphosis group had walking disabilities that did not differ between age groups, whereas gait disturbance in the thoracic kyphosis group showed a positive relation with age. CONCLUSIONS: Posture of the trunk in the sagittal plane was associated not only with the distance and time parameter of gait, but also with functional performance in the elderly.

Knee pain in people aged 80 years and older is not associated with gait parameter and functional performance.

We evaluated the differences in gait and functional performance between two groups of elderly people, one consisting of people between 65 and 79 years of age and the other consisting of people over 80 years of age. We analysed whether knee pain affected gait and looked at the functional performance of the timed 'up and go' (TUG) and functional reach (FR) tests. In 247 community-dwelling people aged 65 years and older, consisting of 90 men and 157 women with a mean age of 80 years (range 65-94 years), 47% had knee pain. Shorter stride, shorter step, slower speed, longer TUG and shorter FR were seen in the group aged 80 years and over compared with the group aged 65-79 years. Knee pain was associated with TUG, especially in the group aged 65-79 years. In the group aged 65-79 years with knee pain, a shorter stride and step length, a longer time required to hold a double stance, a slower walking speed and a longer TUG were shown. However, in the group aged 80 years and over, there was no significant difference between participants with and without knee pain for these parameters.