Changes in the excitability of anterior horn cells in a mental rotation task of body parts.

INTRODUCTION/AIMS: Mental rotation (MR), a tool of implicit motor imagery, is the ability to rotate mental representations of two- or three-dimensional objects. Although many reports have described changes in brain activity during MR tasks, it is not clear whether the excitability of anterior horn cells in the spinal cord can be changed. In this study, we examined whether MR tasks of hand images affect the excitability of anterior horn cells using F-wave analysis. METHODS: Right-handed, healthy participants were recruited for this study. F-waves of the right abductor pollicis brevis were recorded after stimulation of the right median nerve at rest, during a non-MR task, and during an MR task. The F-wave persistence and the F/M amplitude ratio were calculated and analyzed. RESULTS: Twenty participants (11 men and 9 women; mean age, 29.2 ± 4.4 years) were initially recruited, and data from the 18 that met the inclusion criteria were analyzed. The F-wave persistence was significantly higher in the MR task than in the resting condition (p = .001) or the non-MR task (p = .012). The F/M amplitude ratio was significantly higher in the MR task than in the resting condition (p = .019). DISCUSSION: The MR task increases the excitability of anterior horn cells corresponding to the same body part. MR tasks may have the potential for improving motor function in patients with reduced excitability of the anterior horn cells, although this methodology must be further verified in a clinical setting.

Differences in motor imagery strategy change behavioral outcome.

Kinesthetic motor imagery (KMI) involves imagining the feeling and experience of movements. We examined the effects of KMI, number visualizing, and KMI with number visualizing on the excitability of spinal motor neurons and a behavioral outcome measure in a pinch force task. Healthy participants (13 men and 8 women; mean age: 24.8 ± 5.5 years) were recruited. We compared the F-waves of the left thenar muscles after stimulating the left median nerve at the wrist during each motor imagery condition after a practice session. The KMI condition consisted of imagining muscle contraction, the number visualizing condition consisted of imagining the pinch force increasing numerically, and the KMI with number visualizing consisted of alternating between the KMI and imagining the pinch force increasing numerically. Before and after motor imagery, the time required to adjust to the target pinch force was compared. The time required to adjust the pinch force was shorter in the KMI with number visualizing condition than in the KMI and number visualizing conditions. There was no difference in the F/M amplitude ratio between each MI strategy condition, indicating the excitability of spinal motor neurons. Numerical information helped to improve the ability of participants to perform KMI.

Effect of ninjin'yoeito and ginseng extracts on oxaliplatin-induced neuropathies in mice.

Oxaliplatin (L-OHP) is a platinum-based anticancer agent used to treat various types of cancer. It frequently causes acute and chronic peripheral neuropathies, such as cold allodynia and mechanical hyperalgesia. Ninjin'yoeito (NYT) is a formula used in traditional Japanese Kampo medicine to improve recovery from diseases and other medical disorders. We previously reported that treatment with a boiling-water extract of NYT prevented L-OHP-induced damage to neurite-like outgrowths from differentiated PC12 cells. The objectives of the present study were to evaluate the in vivo effects of NYT on L-OHP-induced neuropathic pain in mice and identify the active ingredients in NYT. Treatment with NYT extract significantly ameliorated both cold allodynia and mechanical hyperalgesia induced by L-OHP. While L-OHP treatment suppressed neurite outgrowths from primary dorsal root ganglion cells in vitro, NYT extract blocked this suppression in a concentration-dependent manner. Among the herbal components of NYT, the extract of ginseng (Panax ginseng roots) showed a protective effect against neurite damage induced by L-OHP, and one of its active ingredients was identified as ginsenoside Rg3. Ginseng extract partially relieved L-OHP-induced neuropathic pain in mice. Our results suggest that NYT could be an attractive agent for treating L-OHP-induced neuropathic pain, and that the active ingredient of NYT may be ginseng.

Processed aconite root and its active ingredient neoline may alleviate oxaliplatin-induced peripheral neuropathic pain.

ETHNOPHARMACOLOGICAL RELEVANCE: Processed aconite root (PA, the root of Aconitum carmichaeli, Ranunculaceae) is a crude drug used in traditional Chinese or Japanese kampo medicine to generate heat in the body and to treat pain associated with coldness. Oxaliplatin (L-OHP) is a platinum-based anticancer drug that frequently causes acute and chronic peripheral neuropathies, including cold and mechanical hyperalgesia. AIM OF THE STUDY: We investigated the effects of PA on L-OHP-induced peripheral neuropathies and identified the active ingredient within PA extract. MATERIALS AND METHODS: L-OHP was intraperitoneally injected into mice, and PA boiled water extract was orally administered. Cold and mechanical hyperalgesia were evaluated using the acetone test and the von Frey filament method, respectively. Dorsal root ganglion (DRG) neurons were isolated from normal mice and cultured with L-OHP with or without PA extract. Cell viability and neurite elongation were evaluated. RESULTS: PA extract significantly attenuated cold and mechanical hyperalgesia induced by L-OHP in mice. In cultured DRG neurons, L-OHP reduced cell viability and neurite elongation in a dose-dependent manner. Treatment with PA extract significantly alleviated the L-OHP-induced reduction of neurite elongation, while the cytotoxicity of L-OHP was not affected. Using activity-guided fractionation, we isolated neoline from PA extract as the active ingredient. Neoline significantly alleviated L-OHP-induced reduction of neurite elongation in cultured DRG neurons in a concentration-dependent manner. Moreover, subcutaneous injection of neoline attenuated cold and mechanical hyperalgesia in L-OHP-treated mice. PA extract and neoline did not show sedation and motor impairment. CONCLUSIONS: The present study indicates that PA and its active ingredient neoline are promising agents to alleviate L-OHP-induced neuropathic pain.

Ninjin'yoeito and ginseng extract prevent oxaliplatin-induced neurodegeneration in PC12 cells.

Ninjin'yoeito (NYT) is a formula of Japanese traditional kampo medicine composed of 12 crude drugs, and is designed to improve the decline in constitution after recovery from disease, fatigue, anemia, anorexia, perspiration during sleep, cold limbs, slight fever, chills, persistent cough, malaise, mental disequilibrium, insomnia, and constipation. Oxaliplatin (L-OHP) is a platinum-based anticancer drug used to treat colorectal, pancreatic, and stomach cancers. However, it often causes acute and chronic peripheral neuropathies including cold allodynia and mechanical hyperalgesia. In this study, we investigated the preventive effects of NYT on neuronal degeneration caused by L-OHP using PC12 cells, which are derived from the rat adrenal medulla and differentiate into nerve-like cells after exposure to nerve growth factor. L-OHP treatment decreased the elongation of neurite-like projection outgrowths in differentiated PC12 cells. When PC12 cells were treated with NYT hot water extract, neurodegeneration caused by L-OHP was significantly prevented in a concentration-dependent manner. Among the 12 crude drugs composing NYT, the extract of Ginseng (the root of Panax ginseng) exhibited the strongest preventive effects on neurodegeneration in differentiated PC12 cells. By activity-guided fractionation, we found that the fraction containing ginsenosides displayed preventive activity and, among several ginsenosides, ginsenoside F2 exhibited significant preventive effects on L-OHP-induced decreases in neurite-like outgrowths in differentiated PC12 cells. These results suggest that NYT and ginseng are promising agents for preventing L-OHP-induced neuropathies and present ginsenoside F2 as one of the active ingredients in ginseng.

Effect of chitosan chewing gum on reducing serum phosphorus in hemodialysis patients: a multi-center, randomized, double-blind, placebo-controlled trial.

BACKGROUND: HS219 (40 mg chitosan-loaded chewing gum) is designed to bind salivary phosphorus as an add-on to available phosphorus binders. We performed a randomized, placebo-controlled, double-blind study to evaluate the efficacy and safety of HS219 in hemodialysis (HD) patients with hyperphosphatemia as an add-on to phosphorus binders. METHODS: Sixty-eight HD patients who were maintained on calcium carbonate (n=33) or sevelamer hydrochloride (n=35) were enrolled. The primary end point was a change in serum phosphorus levels. Secondary end points included changes in levels of salivary phosphorus, serum calcium, parathyroid hormone (PTH), and intact fibroblast growth factor (iFGF) 23. RESULTS: Sixty-three patients chewed either HS219 (n=35) or placebo (n=28) for 30 min, three times a day, for 3 weeks. HS219 was well tolerated and safe. However, HS219 was not superior to placebo with additional reduction of serum phosphorus with respect to phosphorus binders at the end of the chewing period. There were no significant effects of HS219 on reduction of salivary phosphorus, serum calcium, iPTH, or iFGF23 levels. CONCLUSIONS: The chitosan-loaded chewing gum HS219 does not affect serum and salivary phosphorus levels in Japanese HD patients with hyperphosphatemia. Our findings do not support previous findings that 20 mg of chitosan-loaded chewing gum reduces serum and salivary phosphorus levels. TRIAL REGISTRATION: [corrected] ClinicalTrials.gov NCT01039428, 24 December, 2009.

Excitability of spinal neural function by motor imagery with isometric opponens pollicis activity: influence of vision during motor imagery.

BACKGROUND: No scientific basis exists for the effect of motor imagery with eyes open. OBJECTIVE: To investigate spinal neural function during motor imagery and at rest with eyes open or closed by analyzing F-waves generated by the left thenar muscles after left median nerve stimulation. METHODS: Sixteen healthy volunteers performed motor imagery while achieving 50% maximal voluntary contraction by isometrically contracting the opponens pollicis muscle. For subjective comparisons after the test, patients were asked whether imaging was easier with eyes open or closed and were then asked to imagine the contraction while holding the sensor between thumb and index finger with eyes open or closed. RESULTS: Persistence during motor imagery under both visual conditions tended to increase compared with that at rest. F/M amplitude ratio was significantly higher during motor imagery under both visual parameters than at rest. Most subjects (14/16) found imaging easier with eyes open, but no relationship was found between F-wave data and subjective evaluations to determine the easier condition for motor imagery. CONCLUSION: Motor imagery with eyes open or closed increased the excitability of spinal neural output to the thenar muscles. However, subjective evaluation to determine the easier visual condition for motor imagery revealed insignificant results.

Excitability of spinal neural function during motor imagery in Parkinson's disease.

the median nerve at the wrist in subjects during two motor imagery conditions: holding and not holding the sensor of a pinch meter between the thumb and index finger. Our aim was to determine whether mental simulation without the muscle contraction associated with motion can increase the excitability of spinal neural function in patients with Parkinson's disease (PD). F-waves of the left thenar muscles were examined in 10 patients with PD under resting, holding and motor imagery conditions. For the holding condition, the subjects held the sensor of the pinch meter between their thumb and index finger. For the motor imagery conditions, the subjects were asked to imagine a 50% maximal voluntary isometric contraction holding and not holding the sensor of the pinch meter between their thumb and index finger (motor imagery "with"/"without sensor"). Persistence during motor imagery under the "with sensor" condition increased significantly compared with persistence during resting (n=10, z=2.2509, p=0.0244, Wilcoxon test). The F/M amplitude ratio during motor imagery under the "with sensor" condition increased significantly compared with that during resting (n=10, z=2.1915, p=0.0284, Wilcoxon test). Excitability of spinal neural function during motor imagery in Parkinson's disease Motor imagery under the "with the sensor" condition increased excitability of the spinal neural output to the thenar muscles. Because excitability of the spinal neural output to the thenar muscles during motor imagery "with the sensor" was significantly higher than that during resting, we suggest that movement preparation for a motor imagery task is important in patients with PD.

Excitability of spinal neural function during several motor imagery tasks involving isometric opponens pollicis activity.

BACKGROUND: It is unclear whether mental simulation without actual muscle contraction associated with actual motion can increase the excitability of the spinal neural function. OBJECTIVE: To determine the best method for mental simulation without actual muscle contraction, we analyzed the F-wave of thenar muscles after stimulating the median nerve by motor imagery whilst holding the sensor of a pinch meter between the thumb and index finger and without holding the sensor. METHODS: Healthy volunteers (n = 11; mean age, 34 years) participated in this study after providing informed consent. We examined the F-wave of the left thenar muscles after stimulating the left median nerve at the wrist at rest and under holding and motor imagery conditions. For the motor imagery condition, the subjects were asked to establish 50% maximal voluntary contraction (MVC) of isometric contraction while holding the sensor between the thumb and index finger (motor imagery with the sensor condition) and without holding the sensor on another day (motor imagery without the sensor condition). RESULTS: The persistence and amplitude ratio of F/M during motor imagery with or without the sensor was better than that during relaxation. In particular, this ratio was significantly higher under the with sensor condition than under the without sensor condition. CONCLUSION: Movement preparation for a motor imagery task involving 50% MVC isometric contraction of the opponens pollicis is important.

Improvement of MBD parameters in dialysis patients by a switch to, and combined use of lanthanum carbonate: Josai Dialysis Forum collaborative study.

The effects of lanthanum carbonate on MBD parameters were investigated in 59 hemodialysis patients who were taking calcium carbonate. Lanthanum carbonate (initial dosage: 750 mg/day), as a replacement for or in combination with calcium carbonate and/or sevelamer hydrochloride, was administered for 12 months with increase/decrease of dosages. Lanthanum carbonate replaced calcium carbonate for 21 cases and was co-administered in 38 cases. It replaced sevelamer hydrochloride in 20 cases and was co-administered in 10 cases. Both the number of cases to which calcium carbonate was administered and their dosages decreased to about 70-80% 12 months after the initiation, and cases administered sevelamer decreased to about 30%. In the cases for which lanthanum carbonate was co-administered, the dosages of calcium carbonate and sevelamer slightly decreased. A significant decrease in serum calcium level was observed. In the serum phosphorus levels (P levels), significant decrease compared with the initial level was observed only at six and nine months. Intact parathyroid hormone (iPTH) level remained stable at around 230 pg/mL without significant change. The dosage of vitamin D and cinacalcet remained without significant change. The results of this trial suggest that, if dosages of vitamin D and cinacalcet are adequately controlled, a switch to lanthanum carbonate and its concomitant use are effective to control the Ca and P levels without changing iPTH levels.

Acupuncture-induced cerebral blood flow responses in dystonia.

OBJECTIVE: The effect of acupuncture (ACP) on regional cerebral blood flow (rCBF) is unclear. Single-photon emission computed tomography studies on three patients with dystonia were performed before and after ACP treatment to test the contention that ACP affects rCBF. METHODS: Pre-ACP and post-ACP CBF study were performed on the same day; 99mTc ethyl cysteinate dimer was injected for each study. rCBF images were analyzed using a three-dimensional stereotaxic ROI template (3DSRT) to objectively measure rCBF. We evaluated rCBF bilaterally in five segments related to the pathophysiology of dystonia (1, superior frontal; 2, middle and inferior frontal; 3, primary sensorimotor; 4, lenticular nucleus; and 5, thalamus). More than 10% left-right asymmetry in rCBF over three continuous slices was defined as significant laterality. Post-ACP rCBF and laterality were evaluated with the pre-ACP rCBF study acting as a control in each subject. RESULTS: The clinical effect of ACP was remarkable in all patients and rCBF increased in most segments. Pre-ACP rCBF exhibited significant laterality in eight segments of the three patients. Laterality reversed in seven of these segments and resolved in the remaining segment after ACP. Pre-ACP rCBF laterality was not preserved in any segment after ACP. The remaining five segments exhibited laterality only after ACP. In total, after ACP, 13 of 15 segments demonstrated a change in CBF that was greater unilaterally. CONCLUSIONS: ACP results in an increase in CBF that is greater unilaterally. We think that unilateral change in CBF may be correlated with the action of ACP on the central nervous system in patients with dystonia.

[Effect of acupuncture treatment for a patient with severe axial dystonia appearing during treatment for schizophrenia].

We performed acupuncture treatment on first consultation for a female 28-year-old patient with severe axial dystonia, causing involuntary movement and abnormal posture of the neck and body, which had developed during treatment for schizophrenia. Involuntary movement involving elevation of the right shoulder began to occur in October X-1. Drugs were prescribed by her doctor, but her involuntary movement worsened and spread to the whole body. Thereafter, she began receiving acupuncture treatment at the out patient clinic for dystonia at the Kansai Medical College Hospital in July X. Involuntary movements of her neck involved repeated left lateral bending or a rigidly straight posture while sitting and standing. Her neck also showed a left lateral bend and right rotation. Her body showed a left lateral bend and right shoulder elevation. The neck problems in this case were induced by a hypertonicity of the left sternocleidomastoid (SCM), which caused the left lateral bending and right rotation of the neck. Problems in her body involved left lateral bending due to hypotonicity of the left abdominal muscle and hypotonicity of the left back muscles, which were unable to control the left lateral bending of the body. The right shoulder elevation was caused by a hypertonicity of the right trapezius and this was another of her problems. Acupuncture treatments were given using a penetrating needle method. The treatment points were left LI4 to decrease the hypertonicity of the left SCM, left ST41 to increase the hypotonicity of the left abdominal muscles, right BL60 to increase the hypotonicity of the right back muscles and right TE5 to decrease the hypertonicity of the right trapezius. At the initial stage of acupuncture treatment, the patient was not able to attend the hospital regularly enough to obtain sufficient improvement by acupuncture. In December X+1, she started to receive acupuncture treatment weekly, and the posture of the neck and body improved. In May X+3, her neck and body postures remained erect while sitting and she did not show involuntary movement. For problems of dystonia, we perform acupuncture treatment, using meridian and acupressure points selected based on the oriental medicine system, and we achieved improvement of symptoms in this case. The patient also achieved improved stability with regard to the symptoms of schizophrenia. It is suggested that acupuncture treatment has had a positive effect on tardive dystonia including axial dystonia.

Enhancement of MML medical data exchange standard for a localized Chinese version.

Medical Markup Language (MML) is a standard for the exchange of medical data among different medical institutions. It was developed in Japan in 1995. Since version 2.21, MML has used eXtensible Markup Language (XML) as a meta-language. The latest version, 3.0, conforms to HL7 Clinical Document Architecture (CDA) and contains 14 modules and 36 data definition tables. In China, a standard which structures entire medical records in XML does not yet exist. Taking advantage of MML's flexibility, we created a localized Chinese version based on MML 3.0. Parts of the original specifications have been enhanced; these include a newly developed health insurance information module and 12 additional or redefined data definition tables. The Chinese version takes local needs into account and now makes it possible to exchange medical data among Chinese medical institutions.