Development of a Lightweight Flexible Construction Work Assist Suit Using Pneumatic Rubber Artificial Muscles.

We developed an assist suit with lightweight, flexible artificial muscles of pneumatic rubber for reducing muscle load in the lumbar region. We designed two assist forces to control the artificial muscles with pulse width modulation based on the measured EMG of the spinal column muscle and estimated the torque of the hip joint. The experimental results confirmed the developed work assist suit could unload muscle activity during bending and stretching exercises. We also proposed to use an EMG measurement device at the wearer's temple to control the assist timing and confirmed the feasibility of detecting the intention of the wearer.

Influence of clinical and genetic factors on warfarin dose requirements among Japanese patients.

OBJECTIVE: The aim of this study was to investigate the influence of clinical and genetic factors on warfarin dose requirements in the Japanese population. METHODS: We enrolled 125 patients on stable warfarin anticoagulant therapy with an international normalized ratio maintained between 1.5 and 3.0. PCR-based methods were performed to analyze genetic polymorphisms in the genes pharmacokinetically and pharmacodynamically related to warfarin reactions, including cytochrome P450 (CYP) 2C9, vitamin K epoxide reductase complex subunit 1 (VKORC1), gamma-glutamyl carboxylase (GGCX) and factor VII (FVII). RESULTS: The presence of CYP2C9*3 and VKORC1-1639G>A had a significant impact on the mean maintenance dose of warfarin (CYP2C9*1/*1 2.74 +/- 1.24 mg/day vs. *1/*3 and *3/*3 1.56 +/- 0.85 mg/day, P = 0.009; VKORC1-1639AA 2.42 +/- 0.95 mg/day vs. GA 3.71 +/- 1.43 mg/day vs. GG 7.25 +/- 0.35 mg/day, P < 0.001). In the multiple linear regression model, the combination of age, body surface area, and genotypes of CYP2C9*3 and VKORC1-1639G>A explained 54.8% of the variance in warfarin dose requirements. CONCLUSIONS: The influences of CYP2C9*3 and VKORC1-1639G>A on the maintenance dose of warfarin were well-defined in Japanese patients, while polymorphisms of GGCX and FVII did not affect it. The model established in this study might provide us most likely individual maintenance dose based on clinical and genetic backgrounds.

Low-intensity anticoagulation for stroke prevention in elderly patients with atrial fibrillation: efficacy and safety in actual clinical practice.

Low-intensity warfarin (INR 1.5 to 2.5) was started in 63 patients with atrial fibrillation (AF) and they were prospectively followed for 2.3 +/- 1.4 years to determine the efficacy and safety of anticoagulation for stroke prevention in actual clinical practice. Although the patients in this practice were older (76 +/- 7 years), consisted of more women (52%), and had more risk factors for stroke compared with those in clinical trials, the annual event rates of stroke and systemic embolism in this practice were comparable to those of patients receiving warfarin in clinical trials (2.0% vs. 1.4% and 0.7% vs. 0.3%). The rate of major bleeding did not significantly differ between this practice and clinical trials (0.7% vs. 1.3%). The rate of minor bleeding was significantly lower in this practice than in clinical trials (3.4% vs. 7.9%). The data suggest that low-intensity anticoagulation is effective and safe for stroke prevention in elderly patients with AF at stroke risk in actual clinical practice.

Predictors of controlled ambulatory blood pressure in treated hypertensive patients with uncontrolled office blood pressure.

Although some treated hypertensive patients have controlled 24-h ambulatory blood pressure (ABP) despite their uncontrolled office blood pressure (BP), the factors relating to the control of 24-h ABP remain unknown. We conducted a study to assess 24-h ABP and its association with other cardiovascular risk factors, including echocardiographic left ventricular hypertrophy (LVH), in elderly hypertensive patients (n =41) with uncontrolled office BP (>140/90 mmHg) during long-term medication. Although a majority of the patients had isolated elevation of office systolic BP (SBP), there was no significant relationship between office SBP and 24-h SBP, and about half of the patients had controlled 24-h ABP (125+/-8/69+/-6 mmHg). Patients with controlled 24-h ABP (125+/-8/69+/-6 mmHg) had similar office BP (150+/-6/77+/-5 vs. 150+/-7/79+/-7 mmHg), but lower left ventricular mass index (LVMI) (123+/-34 vs. 156+/-34 g/m(2)) and body mass index (BMI) (24.4+/-2.1 vs. 26.4+/-3.6 kg/m(2)) compared with those with uncontrolled 24-h ABP (149+/-13/78+/-7 mmHg). Multivariate analysis showed that LVMI and BMI were independently associated with controlled 24-h ABP, and the control status of 24-h ABP was highly dependent on the presence of LVH and obesity. Therefore, absence of LVH and obesity may be useful for predicting the level of control of 24-h ABP in treated patients whose office BP is uncontrolled without ABP measurements.

Factors relating to inadequate control of blood pressure in hypertensive outpatients.

Adequate control of blood pressure (BP) is important for preventing hypertensive complications, but it has been reported that many patients remain uncontrolled despite regular care. We studied the factors contributing to inadequate control of BP. A cohort of hypertensive patients (n = 395) was queried in regard to their quality of life (QOL) and drug compliance, and the characteristics of responders (n = 256) were obtained from their clinical records. The achieved level of BP was determined by the mean of at least five readings at five recent visits. The mean age, BP, and body mass index were 73.0 +/- 8.8 years, 139 +/- 12/76 +/- 8 mmHg, and 24.1 +/- 3.5, respectively. There was no significant relation between the BP level and the QOL score. The patients were divided into 6 groups according to their attending physicians (A, B, C, D, E, and F), and the BP levels were compared among the groups. Systolic BPs were higher in the A (143 +/- 13 mmHg) and the F (145 +/- 12 mmHg) groups than in the B (135 +/- 10 mmHg) group, whereas diastolic BPs were similar among the groups. Moreover, increases in therapy occurred at lower BP levels in the B group (158 +/- 13/83 +/- 14 mmHg, n = 14) than in the A group (173 +/- 21/87 +/- 16 mmHg, n = 8). Other characteristics of the clinical background were similar among the groups. Multivariate analysis indicated that inadequate BP control (> or = 140/90 mmHg) was associated with difference of physicians (A, C, D, or F vs. B), number of antihypertensive drugs ( 2 vs. 1), and increases in therapy (vs. no increases in therapy). These results suggest that physicians' attitudes toward antihypertensive therapy play a crucial role in adequate BP control.

Stroke prevention in patients with atrial fibrillation.

We evaluated the antithrombotic therapy and eligibility for anticoagulation before stroke in 30 patients with atrial fibrillation (AF) admitted to a district hospital in Kochi, Japan from 1992 to 1998. The mean age was 77+/-10 years old. Subtypes of ischemic stroke were classified as possibly cardioembolic in 26 (87%) patients and lacunar in four (13%). Eight (26.7%) patients died in the acute phase and 15 (50%) were disabled at discharge. Most patients were eligible for anticoagulation before stroke because of previously known AF (80%), high risk for stroke (80%), absence of contraindications (83.3%), and good clinical compliance (90%). The prescription rate of warfarin was, however, less than 20% even in high risk patients who needed anticoagulation. In conclusion, underuse of warfarin and high eligibility for anticoagulation in stroke patients with AF suggest that the chance of stroke prevention may be lost in many patients with AF in clinical practice.