Clinical effects of polymyxin B-immobilized fiber column direct hemoperfusion for severe bacterial meningitis: A series of 10 cases.

Our results suggest a possible role for Polymyxin B-immobilized fiber column direct hemoperfusion in combination with standard therapy in the rapid improvement of impaired consciousness in patients with severe bacterial meningitis.

Injuries and disorders among young ice skaters: relationship with generalized joint laxity and tightness.

This study retrospectively investigated 192 teenage speed and figure skaters with prior injuries documented by an athletes' questionnaire, who underwent a physical examination to assess their muscle tightness and generalized joint laxity. In all athletes, the degree of muscle tightness and joint laxity were measured by a standardized physical examination. A descriptive report of the types of injuries showed a predominance of fractures, ligament injuries, enthesitis, and lower back pain. Approximately 5% of all skaters tested positive for tightness, while 25.8% of figure skaters and 15.2% of speed skaters had generalized ligamentous laxity. Statistical testing showed an association between ankle sprains and muscle tightness, and an association between knee enthesitis and muscle tightness in skating athletes. There was also an association between lower back pain and generalized joint laxity, which held true only for the male skaters.

Toe-out angle changes after total knee arthroplasty in patients with varus knee osteoarthritis.

PURPOSE: Toeing-out is a commonly proposed kinematic variable that has been suggested to reduce external knee adduction moment. Analyses of the toe-out angle after total knee arthroplasty (TKA) are useful for obtaining a proper understanding of the abnormal gait caused by varus knee osteoarthritis (OA), as well as performing rehabilitation after arthroplasty. Changes in the toe-out angle after arthroplasty have not yet been defined or analysed. METHODS: The study population consisted of 32 knees in 32 patients with varus knee OA who underwent TKA. The femorotibial angle was evaluated on standing anteroposterior radiographs before and after arthroplasty. The subjects underwent three-dimensional motion capture analyses to measure gait parameters (walking speed, cadence, stride length, step length, step width and the relative length of the single-limb support (SLS) percentage of one gait cycle) and the maximal hip adduction angle in the stance phase, the trunk lean angle in the coronal plane and the toe-out angle before and 4 weeks after arthroplasty. RESULTS: The femorotibial angle on the side of arthroplasty improved after surgery. Among the measured gait parameters, only the SLS percentage increased significantly. The hip adduction angle and toe-out angle on the side of arthroplasty increased significantly after surgery. CONCLUSIONS: The knee alignment and hip adduction angle in the coronal plane and SLS phase were normalized after arthroplasty. The increase in the toe-out angle after arthroplasty may be attributable to the restoration of a normal knee alignment. These findings contribute to obtaining a proper understanding of the abnormal gait caused by varus knee OA and are useful for orthopaedic surgeons and rehabilitation therapists when treating patients after arthroplasty. LEVEL OF EVIDENCE: Prospective study, Level II.

A clinical study of the efficacy of a single session of individual exercise for depressive patients, assessed by the change in saliva free cortisol level.

BACKGROUND: The efficacy of physical exercise as an augmentation to pharmacotherapy with antidepressants for depressive patients has been documented. However, to clarify the effectiveness of exercise in the treatment of depression, it is necessary to distinguish the effect of the exercise itself from the effect of group dynamics. Furthermore, an objective measurement for estimation of the effect is needed. Previous reports adopted a series of group exercises as the exercise intervention and mainly psychometric instruments for the measurement of effectiveness. Therefore, this clinical study was done to examine the effectiveness of a single session of individual exercise on depressive symptoms by assessing the change in saliva free cortisol level, which reflects hypothalamic-pituitary-adrenocortical axis function that is disturbed in depressive patients. METHOD: Eighteen medicated patients, who met the DSM-IV-TR criteria for major depressive disorder, were examined for the change in saliva free cortisol levels and the change in subjective depressive symptoms before and after pedaling a bicycle ergometer for fifteen minutes. Within a month after the exercise session, participants conducted a non-exercise control session, which was sitting quietly at the same time of day as the exercise session. RESULTS: Depressed patients who participated in this study were in remission or in mild depressive state. However, they suffered chronic depression and had disturbed quality of life. The saliva free cortisol level and subjective depressive symptoms significantly decreased after the exercise session. Moreover, the changes in these variables were significantly, positively correlated. On the other hand, although the subjective depressive symptoms improved in the control session, the saliva free cortisol level did not change. CONCLUSION: For the first time in depressive patients, we were able to show a decrease in the saliva free cortisol level due to physical exercise, accompanied by the improvement of subjective depressive symptoms. This identified a possible influence of exercise on the hypothalamic-pituitary-adrenal axis in depression.These results suggest the utility of assessing the effect of physical exercise by saliva free cortisol level in depressive patients who suffer from bio-psycho-social disability.

Immediate effects of physical therapy on gait disturbance and frontal assessment battery in Parkinson's disease.

AIM: To examine whether the Frontal Assessment Battery is associated with the immediate effects of physical therapy on gait disturbance in patients with Parkinson's disease. METHODS: A total of 18 patients with idiopathic Parkinson's disease (Hoehn and Yahr stage range 3-4) who were able to ambulate independently and who were not demented were included. Patients were divided into two groups on the basis of Frontal Assessment Battery scores: the high score group (score ≥ 13, n=11) and the low score group (score ≤ 12, n=7). A 3-D motion analysis system was used to acquire gait parameter data before and after a 30-min physical therapy program. Stride length, step length, cadence, walking velocity, single support time and double support time were measured. The range of motion of the hip, knee and ankle joint, and maximal trunk displacement on the horizontal plane were measured. RESULTS: In the high-score group, significant improvement was observed in walking velocity, stride length and step length, and in the range of motion of the hip and knee joint. Maximal trunk displacement decreased significantly. In contrast, no significant improvement was observed in the low-score group. Multivariate logistic regression analysis showed that Frontal Assessment Battery scores were a predictor of improvement in the range of motion of bilateral hip and knee joints, and maximal trunk displacement. CONCLUSIONS: We showed that the subtests of motor learning of the Frontal Assessment Battery might be associated with the immediate effects of physical therapy on gait disturbance in Parkinson's disease.

Age as a predictor of residual muscle weakness after anterior cruciate ligament reconstruction.

PURPOSE: The objective of this study was to reveal the predicting factors for muscle recovery in the lower extremity after anterior cruciate ligament (ACL) reconstruction. METHODS: One hundred and thirty-five (135) patients who underwent ACL reconstruction using hamstring autograft were evaluated. Exclusion criteria were bilateral ACL injury, chondral treatment and multiple ligament injury. Nonanatomical single-bundle reconstruction (SB) was performed in 79 patients, and anatomical double-bundle reconstruction (DB) was performed in 56 patients. Strength of quadriceps and knee flexion muscles were assessed at 60°/s using a Cybex II dynamometer (Lumex, Ronkonkoma, NY) at 3, 6 and 9 months after ACL reconstruction. Anterior tibial translation and pivot shift test were also evaluated. The medical records were reviewed to extract the following information: age, gender, the amount of pre and postoperative KT 1000, technique of reconstruction (SB or DB) and postoperative knee rotation. RESULTS: No significant difference of muscle recovery in the lower extremity was observed at any time point after ACL reconstruction between the SB and DB groups. The DB group showed significantly better postoperative antero-posterior and rotational knee laxity than the SB group. Logistic regression analysis showed significant correlation with only age and muscle recovery. CONCLUSION: For clinical relevance, there is a risk of muscle recovery delay when ACL reconstruction is performed in elderly patients. Anatomical DB reconstruction resulted in significantly better knee stability, but had no positive effect on muscle recovery. LEVEL OF EVIDENCE: Retrospective study, Level II.

Alternation of trunk movement after arthroplasty in patients with osteoarthritis of the knee.

OBJECTIVE: Trunk movement is important but still little understood after total knee arthroplasty. The alternation of trunk movement was analyzed for use in a postoperative rehabilitation program in the short-term after arthroplasty. MATERIALS AND METHODS: The subjects were 25 patients with knee osteoarthritis (4 males, 21 females). The femorotibial angle was evaluated on standing anteriorposterior radiographs and recorded at pre- and post-arthroplasty. Using three-dimensional motion capture, the gait parameters (cadence, walking speed, stride length, step length, step width), range of motion of lower extremity joints (hip, knee, and ankle), and trunk movement parameters (angle, speed, and displacement) were measured and compared between the pre- and 4th post-arthroplasty week. RESULTS: The femorotibial angles of the arthroplasty side were improved from an average of 189° to 175° after arthroplasty. At the 4th post-arthroplasty week, the range of motion of the hip and knee flexion, hip adduction on the arthroplasty side, and ankle dorsiflexion on the non-arthroplasty side were significantly increased compared to pre-arthroplasty. Among gait parameters, only the stride length increased significantly. Regarding the trunk movement in the coronal plane, the maximal trunk speed to the non-arthroplasty side and maximal trunk displacement to the arthroplasty side were both reduced in a medio-lateral direction; the upward maximal trunk speed on the arthroplasty side increased and the maximal trunk displacement on the non-arthroplasty side decreased significantly in an up-down direction. CONCLUSION: The recovery of hip adduction during the standing phase caused by improvement of knee alignment contributed the reduction of trunk movement to the operated side. In the early post-arthroplasty period, the reduction of trunk movement in the coronal plane is beneficial to maintain trunk balance and prevent falls. Functional recovery of the lower extremities is a long-term process, and sustained functional training is necessary.

Clinical analysis of risk factors for falls in home-living stroke patients using functional evaluation tools.

OBJECTIVES: To identify risk factors associated with falls in home-living stroke patients and to predict falls using patient information and functional evaluation tools. DESIGN: Cohort study. SETTING: Community. PARTICIPANTS: We recruited 101 home-living stroke patients who had hemiparesis and could walk independently with or without supporting devices. Disease duration ranged from 1 to 22 years (mean, 6.1 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The score of each item of the Stroke Impairment Assessment Set (SIAS), and the FIM instrument, sex, age, duration of disease, stroke type, affected side of the body, frequency of rehabilitation, use of sedatives, and Mini-Mental State Examination score were evaluated and the occurrence of falls was observed prospectively for 12 months. RESULTS: Forty-five (44.6%) participants fell, 20 of whom fell repeatedly. A logistic model for predicting falls was refined until it included 4 predictors: memory score on the FIM, range of motion of the lower extremities on the SIAS, duration of disease, and affected side. The predictive value of the logistic model was 86.7%. CONCLUSIONS: Evaluation tools were useful for predicting falls and devising preventive strategies in the high-risk group of home-living stroke patients.

Identification of nitrated proteins in the normal rat brain using a proteomics approach.

BACKGROUND: The nitration of tyrosine has been suggested to play a role in the pathogenesis of neurodegenerative disorders such as amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD) and Alzheimer's disease (AD). METHODS: In the present study, we identified four targets of protein nitration, T-complex polypeptide 1 alpha subunit (TCP-1), neurofilament L (NFL), glial fibrillary acidic protein (GFAP) and clathrin heavy chain (CHC), in the normal rat cortex using a proteomics approach. CONCLUSIONS: There have been no reports on these proteins being identified by proteomics as nitrated forms in the brain. For further study, we have to investigate alterations in these nitrated proteins during aging and in neurodegenerative disorders.

An increase of oxidized coenzyme Q-10 occurs in the plasma of sporadic ALS patients.

We have compared plasma redox status of coenzyme Q-10 in 20 sporadic amyotrophic lateral sclerosis (sALS) patients with those in 20 healthy age/sex-matched controls. A significant increase in the oxidized form of coenzyme Q-10 (sALS=109.3+/-95.2 nM; controls=23.3+/-7.5 nM, P=0.0002) and in the ratio of oxidized form of coenzyme Q-10 to total coenzyme Q-10 (%CoQ-10) (sALS=12.0+/-9.3%; controls=3.2+/-0.9%, P<0.0001) were observed. Moreover, %CoQ-10 correlated significantly with the duration of illness (rho=0.494, P=0.0315). Our finding suggests systemic oxidative stress in the pathogenesis of sALS.

Redox status of plasma coenzyme Q10 indicates elevated systemic oxidative stress in Parkinson's disease.

Oxidative stress is suggested to play an important role in the pathogenesis of Parkinson's disease (PD). However, no elevation of plasma oxidative stress marker has been reported. We measured percent content of the oxidized form of coenzyme Q10 in total coenzyme Q10 (%CoQ-10) because %CoQ-10 has been shown to be a sensitive marker of oxidative stress. A slight but significant elevation in %CoQ-10 was observed in PD patients when compared with age/gender-matched normal subjects, suggesting elevated systemic oxidative stress in PD patients.

Synergistic inhibition of lipid peroxidation by vitamin E and a dopamine agonist, cabergoline.

We examined antioxidant activity of cabergoline, a dopamine agonist, during the aerobic oxidation of phosphatidylcholine liposomes at 37 degrees C. Cabergoline retarded the oxidation initiated with a lipid-soluble initiator significantly better than that with a water-soluble initiator, suggesting that cabergoline locates in the lipid layer of liposomal membranes. Cabergoline inhibited the oxidation of liposomal membranes synergistically with endogenous antioxidants such as ascorbic acid, ubiquinol-10 and vitamin E, and vitamin E was the most efficient synergist. These results suggest that cabergoline may have a neuroprotective effect on the substantia nigra of Parkinsonian patients because of its synergistic antioxidant activity with vitamin E as well as its action on dopamine receptor.

Structural changes in the midbrain with aging and Parkinson's disease: an MRI study.

We measured midbrain structures of 59 subjects with Parkinson's disease (PD) and 140 age- and gender-matched normal subjects without neurological disorders by using T2-weighted MR imaging. There is a significant increase in the maximum distance of the substantia nigra (SND) and a significant decrease in the average distance from the substantia nigra to the red nucleus (SNRND) in patients with PD compared with normal subjects in the 70 years old or less group. These findings may reflect the pathologic increase of iron concentration and the neuronal loss in the region. However, it is difficult to find differences between normal subjects and patients with PD in the greater than 70 years old group in the midbrain structures. These findings based on a large-scale morphometric study provide essential information to evaluate conventional MR images of PD.

Antioxidant properties of carvedilol: inhibition of lipid peroxidation, protein oxidation and superoxide generation.

Oxidative stress has been suggested to be an etiological factor in cerebro- and cardiovascular disorders. We examined antioxidant activities of carvedilol, a beta- and alpha-adrenoreceptor blocker. Carvedilol suppressed lipid auto-oxidation and protein carbonyl formation in brain homogenate in a dose-dependent manner. Carvedilol also suppressed superoxide generation of human neutrophils. These properties of carvedilol should be suitable for treating hypertension resulting in cerebro- and cardiovascular diseases.

Gliomatosis cerebri involving the lumbosacral spinal cord.

We report a 35-year-old man with gliomatosis cerebri, of which fluid-attenuated inversion-recovery (FLAIR) and T2-weighted magnetic resonance (MR) images revealed diffuse and high signal intensity areas in the bilateral cerebral hemispheres, bilateral middle cerebellar peduncles, cerebellum and lumbosacral spinal cord. Malignant features were not detected by 123 I-IMP SPECT, 201TI SPECT, 18F-fluorodeoxyglucose PET or MR spectroscopy. Histopathological examination of biopsy specimens from the right frontal lobe demonstrated diffuse infiltration of neoplastic cells with relative preservation of the underlying cytoarchitecture. Gliomatosis cerebri demonstrating a lumbosacral spinal cord lesion on MR images is rare and thus this case is important from the aspect of the differential diagnosis of spinal cord lesions.

Antioxidant properties of cabergoline: inhibition of brain auto-oxidation and superoxide anion production of microglial cells in rats.

We evaluated the effect of cabergoline on superoxide anion production by rat microglial cells using a 2-methyl-6-(p-methoxyphenyl)-3,7-dihydroimidazo[1, 2-a]pyrazin-3-one-dependent chemiluminescence assay. Cabergoline dose-dependently inhibited superoxide anion production by microglial cells stimulated with phorbol myristate acetate or opsonized zymosan, while it had no superoxide dismutase-like activity. We also studied the effects of cabergoline and alpha-tocopherol on thiobarbituric acid reactive substances formation in homogenized brain-tissue in rats. Cabergoline was stronger than alpha-tocopherol in inhibiting auto-oxidation. While cabergoline is commonly used to treat the motor dysfunction of Parkinson's disease, it may also be effective in inhibiting oxidative stress, a possible mechanism of dopaminergic neuronal degeneration in Parkinson's disease.