Effectiveness of Home-Based Exercises Without Supervision by Physical Therapists for Patients With Early-Stage Amyotrophic Lateral Sclerosis: A Pilot Study.

OBJECTIVE: To verify the effects of structured home-based exercises without supervision by a physical therapist in patients with early-stage amyotrophic lateral sclerosis (ALS). DESIGN: A historical controlled study that is part of a multicenter collaborative study. SETTING: Rehabilitation departments at general hospitals and outpatient clinics with a neurology department. PARTICIPANTS: Patients (N=21) with ALS were enrolled and designated as the home-based exercise (Home-EX) group, and they performed unsupervised home-based exercises. As a control group, 84 patients with ALS who underwent supervised exercise with a physical therapist for 6 months were extracted from a database of patients with ALS and matched with the Home-EX group in terms of their basic attributes and clinical features. INTERVENTION: The Home-EX group was instructed to perform structured home-based exercises without supervision by a physical therapist that consisted of muscle stretching, muscle training, and functional training for 6 months. MAIN OUTCOME MEASURES: The primary outcome was the score on the ALS Functional Rating Scale-Revised (ALSFRS-R), which is composed of 3 domains: bulbar function, limb function, and respiratory function. The score ranges from 0 to 48 points, with a higher score indicating better function. RESULTS: In the Home-EX group, 15 patients completed the home-based exercises for 6 months, and 6 patients dropped out because of medical reasons or disease progression. No adverse events were reported. The Home-EX group was found to have a significantly higher respiratory function subscore and total score on the ALSFRS-R than the control group at follow-up (P<.001 and P<.05, respectively). CONCLUSIONS: Structured home-based exercises without supervision by a physical therapist could be used to alleviate functional deterioration in patients with early-stage ALS.

Modification of Masticatory Rhythmicity Leading to the Initiation of the Swallowing Reflex in Humans.

Modification of movements by proprioceptive feedback during mastication has an important role in shifting from the oral to the pharyngeal phase of swallowing. The aim of this study was to investigate the kinetics of masticatory muscles throughout a sequence of oropharyngeal swallowing and to present a hypothetical model of the involvement of the nervous system in the transition from mastication to the swallowing reflex. Surface electromyographic signals were recorded from the jaw-closing masseter muscles and the jaw-opening suprahyoid muscle group when a piece of bread (3-5 g) was ingested. Participants were not provided any additional instruction regarding how to chew and swallow. In the final stage of mastication, compared with other stages of mastication, the duration between sequential peak times of rhythmic activity of the masseter muscles was prolonged. Electromyography revealed no significant change in the suprahyoid muscle group. Accordingly, contraction of the jaw-closing muscles and the jaw-opening muscles altered from out-of-phase to in-phase. We have presented a hypothetical model based on the results of the present study, in which mastication shifts to the swallowing reflex when feed-forward inputs from rhythm generators for the jaw-closing and the jaw-opening muscles converge onto an assumed "convertor" neuron group concurrently. This model should contribute to understanding the pathophysiology of dysphagia.

Pneumococcal biliary tract infections - How rare are they?

Pneumococcal biliary tract infections (PBTIs) were reported as rare due to the bacterium's bile solubility. The purpose of this study was to determine the occurrence and clinical characteristics of PBTIs. A retrospective case series review was conducted from January 2006 to August 2014 at a tertiary referral university hospital in Japan. Patients with a blood or bile culture positive for Streptococcus pneumoniae diagnosed with definite cholangitis or cholecystitis according to Tokyo Guideline 2013 were enrolled in this study. Data on clinical information, treatments, and outcomes were collected. During 104 months, 48 cases of positive blood cultures and 13 cases of positive bile cultures were recorded, and after excluding 43 and 5 of these, respectively, a total of 10 patients were diagnosed with PBTI. Most patients (9/10) had biliary tract problems and biliary devices in place. PBTIs were not rare; conversely, they were a relatively common cause of pneumococcal bacteremia in this center treating a high volume of biliary tract illnesses.

Epidemiological characteristics of norovirus associated with sporadic gastroenteritis among children from the 2006/2007 to 2011/2012 season in Nara Prefecture, Japan.

The present study aimed to describe the epidemiological characteristics of norovirus (NoV) associated with sporadic gastroenteritis in regional populations of Nara Prefecture, Japan, from the 2006/2007 to 2011/2012 epidemic season. Fecal specimens of sporadic gastroenteritis collected between September 2006 and August 2012 in Nara Prefecture were examined for the presence of NoV by reverse transcription-polymerase chain reaction. The NoV genotype was determined by nucleotide sequence analysis. In total, 274 NoVs associated with sporadic gastroenteritis were identified. We detected 10 different NoV genotypes: GI/3, GI/4, GI/8, GII/2, GII/3, GII/4, GII/6, GII/7, GII/12, and GII/13. A high NoV detection rate of 35.9% was identified in 1-year-old children. Among the 274 NoV isolates, 142 were obtained from males and 131 were obtained from females (the source of one was unknown). The most prevalent genotype was GII/4, accounting for 117 of the 192 different NoVs identified by sequencing. More epidemiological data will be required to determine the epidemiological characteristics of NoVs in other areas of Japan.

High power density of one-compartment H2O2 fuel cells using pyrazine-bridged Fe[M(C)(CN)4] (M(C) = Pt2+ and Pd2+) complexes as the cathode.

Pyrazine-bridged Fe[M(C)(CN)4] complexes (M(C) = Pt(2+) and Pd(2+)) with 3D porous structures were utilized as the cathode of one-compartment H2O2 fuel cells, which operated in 0.3 M H2O2, using a nickel mesh as an anode. The power density of a H2O2 fuel cell using pyrazine-bridged Fe[Pt(CN)4] reached 4.2 mW cm(-2), which is the highest value reported for the one-compartment H2O2 fuel cells. On the other hand, H2O2 fuel cells using pyrazine-bridged M(N)[Pt(CN)4] (M(N) = Co(2+) and Mn(2+)) as the cathodes exhibited power densities lower than 0.01 mW cm(-2), indicating that Fe(2+) ions are indispensable to achieve the high power density.

A robust one-compartment fuel cell with a polynuclear cyanide complex as a cathode for utilizing H2O2 as a sustainable fuel at ambient conditions.

A robust one-compartment H2O2 fuel cell, which operates without membranes at room temperature, has been constructed by using a series of polynuclear cyanide complexes that contain Fe, Co, Mn, and Cr as cathodes, in sharp contrast to conventional H2 and MeOH fuel cells, which require membranes and high temperatures. A high open-circuit potential of 0.68 V was achieved by using Fe3[{Co(III)(CN)6}2] on a carbon cloth as the cathode and a Ni mesh as the anode of a H2O2 fuel cell by using an aqueous solution of H2O2 (0.30 M, pH 3) with a maximum power density of 0.45 mW cm(-2). The open-circuit potential and maximum power density of the H2O2 fuel cell were further increased to 0.78 V and 1.2 mW cm(-2), respectively, by operation under these conditions at pH 1. No catalytic activity of Co3[{Co(III)(CN)6}2] and Co3[{Fe(III)(CN)6}2] towards H2O2 reduction suggests that the N-bound Fe ions are active species for H2O2 reduction. H2O2 fuel cells that used Fe3[{Mn(III)(CN)6}2] and Fe3[{Cr(III)(CN)6}2] as the cathode exhibited lower performance compared with that using Fe3[{Co(III)(CN)6}2] as a cathode, because ligand isomerization of Fe3[{M(III)(CN)6}2] into (FeM2)[{Fe(II)(CN)6}2] (M = Cr or Mn) occurred to form inactive Fe-C bonds under ambient conditions, whereas no ligand isomerization of Fe3[{Co(III)(CN)6}2] occurred under the same reaction conditions. The importance of stable Fe(2+)-N bonds was further indicated by the high performance of the H2O2 fuel cells with Fe3[{Ir(III)(CN)6}2] and Fe3[{Rh(III)(CN)6}2], which also contained stable Fe(2+)-N bonds. The stable Fe(2+)-N bonds in Fe3[{Co(III)(CN)6}2], which lead to high activity for the electrocatalytic reduction of H2O2, allow Fe3[{Co(III)(CN)6}2] to act as a superior cathode in one-compartment H2O2 fuel cells.

[Clinical review of influenza (H1N1) 2009 detected in 2009-2010 and 2010-2011 flu season in Nara Prefecture].

This study is based on clinical information on 894 subjects diagnosed with influenza (H1N1) 2009 in Nara Prefecture from June 15, 2009, to March 4, 2010, and from July 9, 2010, to March 6, 2011. Clinical data for 2009-2010 and 2010-2011 was compared. Results showed that 43% of 2009-2010 subjects were 0-9 years old and 38% were 10-19 years old. They also showed that 25% of 2010-2011 0-9 years old, 20% 10-19 years old, 20% 20-29 years old and 16% 30-39 years old. Both seasons showed a high percentage of subjects 0-9 years old. Numbers of subjects aged 20-39 years old increased in 2010-2011. Results thus suggest that an age shift occurred in subjects, in Nara Prefecture. The most frequent symptom was fever, e.g., 38 degrees C, in 88%. Upper airway inflammation was seen in 68%, lower airway inflammation in 20% and gastroenteritis in 6%. Lower airway inflammation decreased from 20% in 2009-2010 to 7% in 2010-2011. Neuraminidase inhibitor was prescribed for 408 (46%) subjects, oseltamivir for 262 (63%), zanamivir for 120 (29%), peramivir for 10 (2.4%), and laninamivir for 12 (2.9%). Two neuraminidase inhibitors were prescribed for 11 subjects. Oseltamivir prescription rates were lower among subjects 10-19 years old, following guidelines for the use of antiinfluenza drugs.

High incidence of amantadine-resistant influenza AH3 viruses isolated during the 2005-2006 winter season in Nara, Japan.

We examined the incidence of amantadine-resistant influenza AH3 viruses isolated in Nara Prefecture during the 2005-06 winter season. The genetic analyses of the M2 ion channel protein were conducted using reverse transcriptase PCR and direct sequencing. Thirteen out of 18 (72.2%) strains were identified as amantadine-resistant, and this incidence was remarkably higher than those previously recored in Nara Prefecture. Genetic analyses of the viruses revealed that all the anti-drug strains contained a change at position 31 (AGT-->AAT, Ser31Asn) in the M2 gene. One of the 13 amantadine-resistant strains also contained a change at position 27 (GTT-->GCT, Val27Ala). Our data indicate that there has been a significant increase of drug-resistant influenza AH3 viruses in Nara Prefecture, and raise concern about the spread of resistant influenza AH3 viruses in Japan.

Nonspecific effects of gap paradigm on swallowing.

OBJECTIVE: Analogous to the gap paradigm in experiments for saccadic eye movements with very short reaction times, we hypothesized that the initiation of oropharyngeal swallowing movements guided by visual cues are encouraged under experimental conditions using a similar gap paradigm. METHODS: A red visual cue indicating to hold a bolus in the mouth and a blue one indicating to swallow the bolus were sequentially provided on a computer display to 11 healthy participants. The gap period between these cues varied from 0 to 800ms. Swallowing kinetics and kinematics were recorded using surface electromyography and a laser displacement sensor, respectively. RESULTS: In comparison with the no-gap paradigm, the delay from the onset of muscle activities to initiation of movement significantly decreased with a 100- (p<0.01) and 200-ms (p<0.005) gap period. With other gap periods, no significant change was detected in the delay. CONCLUSIONS: Initiation of visually guided swallowing was enhanced by a gap paradigm of 100-200ms. Wrist flexion was boosted in a similar manner. Thus, the gap effect may be a generalized warning effect. SIGNIFICANCE: Our findings might provide insights into the contribution of the basal ganglia to volitional swallowing.

Epidemiological Characteristics of Sapovirus and Human Astrovirus Detected among Children in Nara Prefecture, Japan, during the 2009/2010-2014/2015 Seasons.

The current study elucidated the epidemiological characteristics of sapovirus (SaV) and human astrovirus (HAstV) associated with gastroenteritis among children in regional populations of Nara Prefecture, Japan, during the 2009/2010-2014/2015 seasons. The SaV detection rate was 7.5% (71/948) according to reverse transcription-polymerase chain reaction. A high SaV detection rate of 13.5% was observed among children 4 years of age. The highest SaV detection rate was observed in June (19.2%), followed by July (11.1%). The detected SaV included 7 genotypes: GI.1, GI.2, GII.3, GII.1, GI.3, GII.2, and GV, in order of decreasing prevalence. In comparison, the HAstV detection rate was 4.2% (40/948). The HAstV detection rate among children 4 years of age was 12.2%. The HAstV detection rate was highest in July (13.9%), followed by May (10.5%) and August (6.7%). The detected HAstVs included genotypes 1, 4, 6, and 8. The most prevalent genotype was 1, followed by 4 and 8. This report provides an epidemiological overview of SaV and HAstV infection in Nara Prefecture, Japan.

Seawater usable for production and consumption of hydrogen peroxide as a solar fuel.

Hydrogen peroxide (H2O2) in water has been proposed as a promising solar fuel instead of gaseous hydrogen because of advantages on easy storage and high energy density, being used as a fuel of a one-compartment H2O2 fuel cell for producing electricity on demand with emitting only dioxygen (O2) and water. It is highly desired to utilize the most earth-abundant seawater instead of precious pure water for the practical use of H2O2 as a solar fuel. Here we have achieved efficient photocatalytic production of H2O2 from the most earth-abundant seawater instead of precious pure water and O2 in a two-compartment photoelectrochemical cell using WO3 as a photocatalyst for water oxidation and a cobalt complex supported on a glassy-carbon substrate for the selective two-electron reduction of O2. The concentration of H2O2 produced in seawater reached 48 mM, which was high enough to operate an H2O2 fuel cell.

Oseltamivir-resistant seasonal A(H1N1) and A(H1N1)pdm09 influenza viruses from the 2007/2008 to 2012/2013 season in Nara Prefecture, Japan.

We examined the incidence of oseltamivir-resistant seasonal A(H1N1) and A(H1N1)pdm09 influenza viruses from the 2007/2008 to 2012/2013 season in Nara Prefecture, Japan. To detect the oseltamivir resistance marker in neuraminidase (NA), 365 influenza viruses (60 seasonal A(H1N1) and 305 A(H1N1)pdm09) were sequenced. The H275Y mutation in the NA gene, which confers resistance to oseltamivir, was identified in 93.8% (30/32) of seasonal A(H1N1) viruses that were circulating during the 2008/2009 season. Moreover, the detection rate of oseltamivir-resistant A(H1N1)pdm09 viruses was 4.1% (3/74) and 2.8% (5/180) in the 2009/2010 and 2010/2011 season, respectively. Four cases of oseltamivir-resistant A(H1N1)pdm09 virus infection occurred in the same hematology ward during the 2010/2011 season. Our data show a low frequency of oseltamivir-resistant A(H1N1)pdm09 virus in Nara Prefecture but suggested the possibility of human-to-human transmission of this virus.