Reduced center of mass acceleration during regular walking with electromyography biofeedback.

BACKGROUND: Regular walking in healthy adults is known to be kinematically stable, but it is unclear how to further kinematically stabilize regular walking. Electromyography biofeedback (EMG-BF) during walking improves walking ability in patients. However, the effect of EMG-BF on walking stability in healthy adults is unknown. Therefore, this study aimed to investigate whether EMG-BF enhances the stability of regular walking in healthy adults. RESEARCH QUESTION: Does the EMG-BF enhance the stability of regular walking in healthy adults? METHODS: Auditory biofeedback of single muscle activity was given to twelve participants during regular walking. The target muscles were the ankle plantar flexor, ankle dorsiflexor, and knee flexor. We compared the root mean square of the center of mass acceleration (RMS-CoMacc), which represents walking smoothness, between biofeedback conditions. RESULTS: We found that EMG-BF during regular walking partially reduced the RMS-CoMacc (p = 0.01). In particular, biofeedback of the ankle plantar flexor muscle reduced the RMS-CoMacc in both the anteroposterior and vertical directions. In the mediolateral RMS-CoMacc, no significant difference was found (p = 0.24). SIGNIFICANCE: Our study is novel because it is the first study to reveal the impact of EMG-BF on the stability of walking among healthy adults. It identifies the key muscles for EMG-BF, potentially leading to the development of a more effective EMG-BF system in the rehabilitation. Especially, biofeedback of the ankle plantar flexor muscle could improve walking stability in both the anteroposterior and vertical directions. The effect of EMG-BF for reducing the RMS-CoMacc during regular walking might depend on the target muscles of biofeedback.

Causes of Death in Elderly Patients With Non-Valvular Atrial Fibrillation　- Results From the ANAFIE Registry.

BACKGROUND: Previous studies on mortality in atrial fibrillation (AF) included a limited number of elderly patients receiving direct oral anticoagulants (DOACs). This subanalysis of the ANAFIE Registry evaluated 2-year mortality according to causes of death of elderly non-valvular AF (NVAF) patients in the DOAC era.Methods and Results: The ANAFIE Registry was a multicenter prospective observational study. Mean patient age was 81.5 years and 57.3% of patients were male. Of the 32,275 patients completing the study, 2,242 died. The most frequent causes of death were cardiovascular (CV) death (32.4%), followed by infection (17.1%) and malignancy (16.1%). Incidence rates of CV-, malignancy-, and infection-related death were 1.20, 0.60, and 0.63 per 100 person-years, respectively. Patients aged ≥85 years showed increased proportions of non-CV and non-malignancy deaths and a decreased proportion of malignancy deaths compared with patients aged <85 years. The incidence of death due to congestive heart failure/cardiogenic shock, infection, and renal disease was higher in patients aged ≥85 than those aged <85 years. Compared with warfarin, DOACs were associated with a significantly lower risk of death by intracranial hemorrhage, ischemic stroke, and renal disease. CONCLUSIONS: This subanalysis described the mortality according to causes of death of Japanese elderly NVAF patients in the DOAC era. Our results imply that a more holistic approach to comorbid conditions and stroke prevention are required in these patients.

Two Manganese Peroxidases and a Laccase of Trametes polyzona KU-RNW027 with Novel Properties for Dye and Pharmaceutical Product Degradation in Redox Mediator-Free System.

Two manganese peroxidases (MnPs), MnP1 and MnP2, and a laccase, Lac1, were purified from Trametes polyzona KU-RNW027. Both MnPs showed high stability in organic solvents which triggered their activities. Metal ions activated both MnPs at certain concentrations. The two MnPs and Lac1, played important roles in dye degradation and pharmaceutical products deactivation in a redox mediator-free system. They completely degraded Remazol brilliant blue (25 mg/L) in 10-30 min and showed high degradation activities to Remazol navy blue and Remazol brilliant yellow, while Lac1 could remove 75% of Remazol red. These three purified enzymes effectively deactivated tetracycline, doxycycline, amoxicillin, and ciprofloxacin. Optimal reaction conditions were 50 °C and pH 4.5. The two MnPs were activated by organic solvents and metal ions, indicating the efficacy of using T. polyzona KU-RNW027 for bioremediation of aromatic compounds in environments polluted with organic solvents and metal ions with no need for redox mediator supplements.

Does Japanese Citrus Fruit Yuzu (Citrus junos Sieb. ex Tanaka) Fragrance Have Lavender-Like Therapeutic Effects That Alleviate Premenstrual Emotional Symptoms? A Single-Blind Randomized Crossover Study.

OBJECTIVE: A majority of menstruating women experience some degree of regular recurrences of diverse symptoms-commonly known as premenstrual syndrome (PMS)-during the days before menstruation. Given the multifactorial etiology of PMS, no single treatment is universally recognized as effective, and many women turn to alternative modalities, including aromatherapy. The present study investigated therapeutic effects on premenstrual symptoms using fragrance from yuzu, a Japanese citrus fruit (Citrus junos Sieb. ex Tanaka), and aromatherapy, from the perspective of autonomic nervous system function. SUBJECTS: Seventeen women in their 20s with subjective premenstrual symptoms. DESIGN: A single-blind randomized crossover study. SETTINGS/LOCATION: This study was performed at a laboratory in a university in Osaka, Japan. Subjects were examined on two separate occasions in the luteal phase. OUTCOME MEASURES: Using two aromatic stimulation sources (yuzu and lavender used as the control), this experiment measured heart rate variability (HRV) reflecting autonomic nerve activity and the Profile of Mood States (POMS) as a psychologic index before and after aromatic stimulation. RESULTS: A scant 10-min inhalation of the yuzu scent significantly decreased heart rate and increased high-frequency power of HRV, reflecting parasympathetic nerve activity, in the luteal phase. Additionally, POMS tests demonstrated that inhalation of the yuzu essential oil significantly decreased three negative subscales: tension-anxiety, anger-hostility, and fatigue-common premenstrual symptoms, together with a total mood disturbance as a global measure of affective state, as long as 35 min after the aroma stimulation. These premenstrual psychoneurophysiologic effects of yuzu fragrance did not differ from those of the effects of lavender. CONCLUSIONS: The present study indicated that short-term inhalation of yuzu fragrance could alleviate premenstrual emotional symptoms, which, at least in part, is attributable to the improvement of parasympathetic nervous system activity. This study further implies that yuzu fragrance aromatherapy might serve as an anti-PMS modality, given its comparable psychoneurophysiologic effects to those of lavender, a representative relaxing scent.

Toxic tau oligomer formation blocked by capping of cysteine residues with 1,2-dihydroxybenzene groups.

Neurofibrillary tangles, composed of hyperphosphorylated tau fibrils, are a pathological hallmark of Alzheimer's disease; the neurofibrillary tangle load correlates strongly with clinical progression of the disease. A growing body of evidence indicates that tau oligomer formation precedes the appearance of neurofibrillary tangles and contributes to neuronal loss. Here we show that tau oligomer formation can be inhibited by compounds whose chemical backbone includes 1,2-dihydroxybenzene. Specifically, we demonstrate that 1,2-dihydroxybenzene-containing compounds bind to and cap cysteine residues of tau and prevent its aggregation by hindering interactions between tau molecules. Further, we show that orally administered DL-isoproterenol, an adrenergic receptor agonist whose skeleton includes 1,2-dihydroxybenzene and which penetrates the brain, reduces the levels of detergent-insoluble tau, neuronal loss and reverses neurofibrillary tangle-associated brain dysfunction. Thus, compounds that target the cysteine residues of tau may prove useful in halting the progression of Alzheimer's disease and other tauopathies.

Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player.

Percutaneous endoscopic discectomy (PED) is the least invasive disc surgery available at present. The procedure can be performed under local anesthesia and requires only an 8 mm skin incision. Furthermore, damage to the back muscle is considered minimal, which is particularly important for disc surgery in athletes. However, employing the transforaminal (TF) PED approach at the lumbosacral junction can be challenging due to anatomical constraints imposed by the iliac crest. In such cases, foraminoplasty is required in addition to the standard TF procedure. A 28-year-old man who was a very active rugby player visited us complaining of lower back and left leg pain. His visual analog scale (VAS) score for pain was 8/10 and 3/10, respectively. MRI revealed a herniated nucleus pulposus at L5-S level. TF-PED was planned; however, the anatomy of the iliac crest was later found to prevent access to the herniated mass. Foraminoplasty was therefore performed to enlarge the foramen, thereby allowing a cannula to be passed through the foramen into the canal without causing exiting nerve injury. The herniated mass was then successfully removed via the TF-PED procedure. Pain resolved after surgery, and his VAS score decreased to 0/10 for both back and leg pain. The patient returned to full rugby activity 8 weeks after surgery. In conclusion, even with an intracanalicular herniated mass at the lumbosacral junction, a TF-PED procedure is possible if additional foraminoplasty is adequately performed to enlarge the foramen.

Percutaneous endoscopic lumbar discectomy for a huge herniated disc causing acute cauda equina syndrome: a case report.

Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.

[Quantification and improvement of speech transmission performance using headphones in acoustic stimulated functional magnetic resonance imaging].

Functional magnetic resonance imaging (fMRI) has made a major contribution to the understanding of higher brain function, but fMRI with auditory stimulation, used in the planning of brain tumor surgery, is often inaccurate because there is a risk that the sounds used in the trial may not be correctly transmitted to the subjects due to acoustic noise. This prompted us to devise a method of digitizing sound transmission ability from the accuracy rate of 67 syllables, classified into three types. We evaluated this with and without acoustic noise during imaging. We also improved the structure of the headphones and compared their sound transmission ability with that of conventional headphones attached to an MRI device (a GE Signa HDxt 3.0 T). We calculated and compared the sound transmission ability of the conventional headphones with that of the improved model. The 95 percent upper confidence limit (UCL) was used as the threshold for accuracy rate of hearing for both headphone models. There was a statistically significant difference between the conventional model and the improved model during imaging (p < 0.01). The rate of accuracy of the improved model was 16 percent higher. 29 and 22 syllables were accurate at a 95% UCL in the improved model and the conventional model, respectively. This study revealed the evaluation system used in this study to be useful for correctly identifying syllables during fMRI.

Impact of phase difference between cardiac systole and skeletal muscle contraction on hemodynamic response during electrically-induced muscle contractions.

Percutaneous low-frequency electrical muscle stimulation (LF-ES) is a new alternative exercise prescription for individuals who cannot adequately perform voluntary exercise. However, substantial undesirable elevation of both systolic blood pressure (SBP) and cardiac afterload occurs during LF-ES and must be resolved. Therefore, this study examined whether or not the synchrony between cardiac systole and skeletal muscle contraction affects instantaneous blood pressure and cardiac afterload during intermittent evoked muscle contractions. In eight subjects, the quadriceps and biceps femoris muscles of each limb were simultaneously stimulated at 20 Hz with a duty cycle of 0.3s stimulation and 0.7s pause for 15 min. The phase difference between the ECG R-peak and the onset of muscle contraction (tau(c-s)) was measured for all heartbeats. Then, instantaneous SBP, tension-time index (TTI), and peripheral vascular resistance (PVR) associated with each heartbeat were plotted as functions of tau(c-s). The results showed that SBP, TTI, and PVR were significantly lowered at positive tau(c-s) (i.e., the moment at which a muscle contraction started during the cardiac recovery phase). These results suggest that a well-designed stimulator, one that induces muscle contractions coupled with heartbeats with appropriate phase difference, would effectively attenuate the elevation of SBP and cardiac afterload during LF-ES.

Enzymatic properties of two catalytic modules of Clostridium stercorarium pectate lyase Pel9A.

Clostridium stercorarium F-9 pectate lyase Pel9A is a modular enzyme composed of two hypothetical family-9 catalytic modules of the polysaccharide lyases, CM9-1 and CM9-2, in order from the N terminus. In this study, we constructed and characterized CM9-1 and CM9-2 polypeptides as rCM9-1 and rCM9-2 respectively. Both of them, like the full-length Pel9A, required the Ca2+ ion for their enzyme activities and showed high activity toward polygalacturonic acid but lower activity toward pectin. The specific activity of rCM9-2 was three times higher than that of rCM9-1 and rCM9-2 by itself efficiently catalyzed the depolymerization reaction of polygalacturonic acid into monosaccharide as the major product. It was found that rCM9-1 and rCM9-2 adsorbed to polygalacturonic acid and pectin on native affinity PAGE analysis, suggesting that they contain an independent carbohydrate-binding module separable from a catalytic module or consist of a catalytic module with a binding affinity for pectic substrates.

A novel thermophilic pectate lyase containing two catalytic modules of Clostridium stercorarium.

The Clostridium stercorarium F-9 pel9A gene encodes a pectate lyase Pel9A consisting of 1,240 amino acids with a molecular weight of 135,171. The mature form of Pel9A is a modular enzyme composed of two family-9 catalytic modules of polysaccharide lyases, CM9-1 and CM9-2, in order from the N terminus. Pel9A showed an overall sequence similarity to the hypothetical pectate lyase PelX of Bacillus halodurans (sequence identity 53%), and CM9-2 showed moderate sequence similarities to some pectate lyases of family 9. Sequence identity between CM9-1 and CM9-2 was 21.3%. The full-length Pel9A lacking the N-terminal signal peptide was expressed, purified, and characterized. The enzyme required Ca(2+) ion for its enzyme activity and showed high activity toward polygalacturonic acid but lower activity toward pectin, indicating that Pel9A is a pectate lyase. Immunological analysis using an antiserum raised against the purified enzyme indicated that Pel9A is constitutively synthesized by C. stercorarium F-9.

Electrophysiology and kinesiology for health and disease.

This paper summarizes my Basmajian keynote presentation at the 2004 International Society of Electrophysiology and Kinesiology Conference. I dedicate this paper to Dr. Herbert A. deVries, the mentor of my research career. The following topics will be covered from the standpoint of Electrophysiology and Kinesiology for health and disease: (1) electromechanical manifestations of neuromuscular fatigue and muscle soreness, (2) cardiac depolarization-repolarization characteristics of normal and patients, (3) etiology of obesity and diabetes and autonomic nervous system, and (4) functional electrical stimulation for health and disease, respectively.