The development of a flexion range-of-motion-adjustable knee joint for knee-ankle-foot orthoses and evaluation of gait in healthy individuals wearing it.

[Purpose] To develop a knee joint for knee-ankle-foot orthoses that is easy to operate and allows for four levels of knee-flexion-movement adjustment, and to determine the effects of different flexion ranges of motion on knee flexion angle during gait. [Participants and Methods] Participants were eight healthy adults. Knee joint for knee-ankle-foot orthoses were made for each participant, and the knee flexion angle during gait was measured for each of the four knee joint settings: fixed in extension, 15° flexion range, 30° flexion range, and free flexion. [Results] Gait analysis showed that the knee flexion angle in the loading response phase was significantly greater in the 15° flexion range, 30° flexion range, and free-flexion settings than in the fixed-in-extension setting. While in the swing phase, the angle was greatest in the fixed setting, followed by the 15° flexion, 30° flexion, and free settings. [Conclusion] The proposed knee joint, when used in post-stroke gait practice using knee-ankle-foot orthoses, allows the gradual increase in the flexion range of motion of the joint as the weight-bearing capability of the lower limb improves, which would enable task-oriented practice similar to walking with ankle-foot orthoses as the next-stage target movement.

Switching cisplatin to carboplatin in chemotherapy for metastatic penile cancer in a patient intolerant to cisplatin.

Introduction: Cisplatin is currently the key drug in the chemotherapy regimen for metastatic penile cancer. There are few reports of alternative medicines for patients who cannot tolerate cisplatin. This report describes a case in which carboplatin was used instead. Case presentation: The patient presented with a chief complaint of edema in the groin area. On close examination, penile cancer (cT2-3N3M0 stage IV) with pelvic lymph node metastasis was diagnosed. He was started on chemotherapy with cisplatin (50 mg/m2 on days 1 and 2), paclitaxel (120 mg/m2 on day 1), and 5-fluorouracil (1000 mg/m2 on days 2-5), but he developed acute kidney failure on the 12th day, thought to be caused by cisplatin. Cisplatin was changed to carboplatin, and chemotherapy was continued. He has received nine courses of chemotherapy and is doing well. Conclusion: A case of penile cancer safely and effectively treated with chemotherapy using carboplatin was reported.

Cerebral Edema Due to Chemotherapeutic Wafer Implantation for Malignant Glioma: Registry Study of Correlation with Perioperative Epileptic Seizures.

Factors predicting adverse events following implantation with wafers containing 1,3-bis(2-chloroethyl)-1-nitrosourea (carmustine, BCNU), which is used in local chemotherapy for malignant gliomas (MGs), are unknown. The association between cerebral edema (CE), which often occurs after implantation, and perioperative seizures, which are often observed in MG cases, is under debate. This study investigated risk factors for CE associated with BCNU wafer implantation and their relationship with perioperative seizures. A total of 31 surgical cases involving 28 adult patients who underwent BCNU wafer implantation for MGs were investigated and classified into those with and without postoperative transient CE. We assessed the correlations between CE caused by BCNU implantation and various factors, including postoperative epileptic seizures. World Health Organization (WHO) grade III MGs significantly affected postoperative CE (p = 0.003) and the occurrence of seizures (p = 0.0004). Factors predictive of postoperative seizures were WHO grade III MGs (p = 0.0026), increased postoperative CE (p = 0.0272), and history of preoperative seizures (p = 0.0316). Postoperative CE, WHO grade III MGs, and a history of preoperative seizures might predict the postoperative occurrence of seizures, necessitating stringent management of seizures and CE in the affected patients.

Hydrogen and methane gases are frequently detected in the stomach.

AIM: To investigate the incidence of bacterial overgrowth in the stomach by using a new endoscopic method in which intragastric hydrogen and methane gases are collected and analyzed. METHODS: Studies were performed in 490 consecutive patients undergoing esophagogastroscopy. At endoscopy, we intubated the stomach without inflation by air, and 20 mL of intragastric gas was collected through the biopsy channel using a 30 mL syringe. Intragastric hydrogen and methane concentrations were immediately measured by gaschromatography. H pylori infection was also determined by serology. RESULTS: Most of intragastric hydrogen and methane levels were less than 15 ppm (parts per million). The median hydrogen and methane values (interquartile range) were 3 (1-8) ppm and 2 (1-5) ppm, respectively. The high hydrogen and methane levels for indication of fermentation were decided if the patient had the values more than 90 percentile range in each sample. When a patient had a high level of hydrogen or methane in one or more samples, the patient was considered to have fermentation. The overall incidence of intragastric fermentation was 15.4% (73/473). Intragastric methane levels were higher in the postoperative group than in other groups. None of the mean hydrogen or methane values was related to H pylori infection. CONCLUSION: Hydrogen and methane gases are more frequently detected in the stomach than expected, regardless of the presence of abdominal symptoms. Previous gastric surgery influences on the growth of methane-producing bacteria in the fasting stomach.

Seventy-five gram glucose tolerance test to assess carbohydrate malabsorption and small bowel bacterial overgrowth.

AIM: To investigate non-invasively the incidence of absorption of carbohydrates in diabetic patients during an oral glucose tolerance test (OGTT) and to determine whether malabsorption may be associated with insulin secretion and insulin resistance. METHODS: A standard 75-g OGTT was performed in 82 diabetic patients. The patients received 75 g of anhydrous glucose in 225 mL of water after an overnight fasting and breath samples were collected at baseline and up to 120 min after ingestion. Breath hydrogen and methane concentrations were measured. Blood glucose and serum insulin concentrations were measured before ingestion and at 30, 60, 90, 120 min post-ingestion. RESULTS: When carbohydrate malabsorption was defined as subjects with an increase of at least 10 ppm (parts per million) in hydrogen or methane excretion within a 2-h period, 28 (34%) had carbohydrate malabsorption. According to the result of increased breath test, 21 (75%) patients were classified as small bowel bacterial overgrowth and 7 (25%) as glucose malabsorption. Patients with carbohydrate malabsorption were older and had poor glycemic control as compared with those without carbohydrate malabsorption. The HOMA value, the sum of serum insulin during the test and the Delta insulin/Delta glucose ratio were greater in patients with carbohydrate malabsorption. CONCLUSION: Insulin resistance may be overestimated by using these markers if the patient has carbohydrate malabsorption, or that carbohydrate malabsorption may be present prior to the development of insulin resistance. Hence carbohydrate malabsorption should be taken into account for estimating insulin resistance and beta-cell function.

Expression of cytochromes p450 in fetal, infant, and juvenile liver of cynomolgus macaques.

Preclinical data of fetal, infant, and juvenile animals are important for the prediction of drug toxicity in fetuses and children. However, expression of drug-metabolizing enzymes, including cytochromes P450 (CYPs), have not been fully investigated in fetal, infant, or juvenile liver of the cynomolgus macaque, an animal species important for preclinical studies. In this study, hepatic expression of 20 cynomolgus macaque CYPs (mfCYPs) in the CYP1-4 subfamilies that are relevant to drug metabolism was measured in fetuses, infants, and juveniles using DNA microarrays. Expression of most mfCYPs, including those moderately or abundantly expressed in postnatal livers such as mfCYP2A23, mfCYP2A24, mfCYP2B6, mfCYP2C9, mfCYP2C19, mfCYP2C76, mfCYP2D17, mfCYP2E1 mfCYP3A4, and mfCYP3A5, was much less abundant in fetal livers, but increased substantially after birth. In contrast, expression of mfCYP2C8 in fetal livers was not substantially different from postnatal livers. Since human CYP3A7 is expressed more abundantly in fetal livers than in adult livers, mfCYP3A7, an ortholog of human CYP3A7, was analyzed by quantitative polymerase chain reaction. Expression of mfCYP3A7 in fetal livers was much lower than that in postnatal livers, and greatly increased after birth, unlike the expression of human CYP3A7. These results indicate that expression of most mfCYPs examined was low in fetal livers, but increased greatly in postnatal livers, with a few exceptions such as mfCYP2C8.