Video analysis of safety and reproducibility issues with the timed up-and-go test applied to patients with Parkinson's disease.

PURPOSE: Falls are a major problem and cause poor quality of life and reduced life expectancy in people affected by Parkinson's disease (PD). The timed up-and-go (TUG) test is the most popular test of walking ability in patients with PD. However, it carries a risk of falls because patients are told to walk as quickly as possible. The purpose of this study was to characterise issues of safety and reproducibility arising in TUG tests. METHODS: Our population was 7 hospitalised patients (4 men, 3 women) with PD and 1 healthy control. We used video capture, Motion Analyser software, and an innovative Yorisoi (snuggling nursing robot) robot. RESULTS: We found the same movements when patients walked in time to a verbal rhythm provided by the physiotherapist and when they used the robot in walking. The TUG times were longest when the therapist provided no intervention. The typical PD patient experienced freezing of gait when rounding the reflective cone marker in the TUG test, and after turning, experienced gait festination. The patient thus encountered difficulty in using the reflective marker. Moreover, because of the characteristic PD shuffling gait, the patient's steps were difficult to count automatically. After the turn, the patient's body leaned heavily; however, if the physiotherapist or the robot applied a light force in the direction of the positive axis, it was possible to prevent a fall. CONCLUSIONS: When applied to patients with PD, the TUG test requires modifications for safety and more accurate step counting to improve reproducibility.IMPLICATIONS FOR REHABILITATIONThe presence of a sense of security with the attendant or the robot is related to walking speed.The TUG test must be reproducible in patients with PD, regardless of whether there is a rhythm or an attendant, and must be able to count the steps in a shuffling gait.The TUG test must consider safety in patients with PD, because it is easier to fall after a turn and when sitting on a chair, and it is instructed to be in hurry walk.After making a turn, a patient's body may lean heavily; however, if a physiotherapist or a Yorisoi (snuggling nursing robot) robot applies a light force in the direction of the positive axis, it is possible to prevent a fall.Assertive technology, such as the Yorisoi robot, may be used to improve the safety TUG test in patients with PD.

Investigation of the Treatment and Living Assistance Needed by Patients with Young-Onset Parkinson's Disease.

PURPOSE: This study assessed the symptoms, treatment, social systems use, and perception of living conditions of patients with young-onset Parkinson's disease (YOPD), and investigated the support needed by them. METHOD: Among the 252 people who completed our questionnaire, we defined YOPD patients as those diagnosed as young onset or those with onset at ≤40 years. The data were compared with others. RESULTS: There were 24 patients with YOPD (9.5%) (average age: 61.7 years), with an average disease duration 6.4 years longer (p < 0.01) and time until diagnosis 0.7 years longer (p < 0.1) than those of other patients. This group took 1.6 times more types of medicines, and time to their next appointment was 8.6 days shorter than that of other patients (p < 0.05). Patients with YOPD had more pulsive walking and more sweating (p < 0.05), and more motor fluctuation (p < 0.1). More patients with YOPD had a physical disability certificate but felt they were not obtaining the required services (p < 0.05). 45.0% of the YOPD group wanted to work more, more used information and communication equipment (p < 0.05), and more felt their medications were adequate (p < 0.1). CONCLUSIONS: Increased awareness of YOPD is needed. YOPD patients have motor fluctuation because of the longer disease duration. Thus, the support of doctors and nurses, and frequent examination visits, are indispensable for controlling symptoms to achieve middle age developmental tasks. Increased support for care-giving, leisure-time activities, and work is also necessary and may help maintain the desire to work in this group.

Evaluation of plant contamination in metabarcoding diet analysis of a herbivore.

Fecal DNA metabarcoding is currently used in various fields of ecology to determine animal diets. Contamination of non-food DNA from complex field environments is a considerable challenge to the reliability of this method but has rarely been quantified. We evaluated plant DNA contamination by sequencing the chloroplast trnL P6 loop region from food-controlled geese feces. The average percentage of contaminant sequences per sample was 1.86%. According to the results of generalized linear models, the probability of contamination was highest in samples placed in wet soil. The proportion of contaminant sequences was lowest at the earliest sampling point and was slightly higher in samples placed in open conditions. Exclusion of rare OTUs (operational taxonomic units) was effective for obtaining reliable dietary data from the obtained sequences, and a 1% cutoff reduced the percentage of contaminated samples to less than 30%. However, appropriate interpretation of the barcoding results considering inevitable contamination is an important issue to address. We suggest the following procedures for fecal sampling and sequence data treatment to increase the reliability of DNA metabarcoding diet analyses: (i) Collect samples as soon as possible after deposition, (ii) avoid samples from deposits on wet soil, and (iii) exclude rare OTUs from diet composition estimations.

Therapeutic effect of lyophilized, Kefir-fermented milk on constipation among persons with mental and physical disabilities.

AIM: Constipation is a serious problem for persons with mental and physical disabilities in Japan. However, prophylaxis is extremely difficult because the major causes of constipation in these individuals are related to their mental and physical disabilities. Constipation can be successfully treated with glycerol enemas (GEs) and other aperients. As constipation is a lifetime issue for these persons, dietary regimens to prevent constipation can be important. METHODS: This study evaluated the probiotic effects of kefir-fermented milk for preventing constipation in 42 persons with mental and physical disabilities. The participants were administered 2 g of lyophilized kefir with each meal for 12 weeks and their bowel movements, the administration of GE and other aperients, and stool shape were recorded. RESULTS: The intake of kefir significantly reduced constipation, compared with the baseline status. Some individuals showed complete relief of constipation, whereas others showed no effect. CONCLUSION: Despite individual variations, consuming kefir daily could prevent constipation.

Eosinophilic plasmacytic conjunctivitis concurrent with gingival fistula caused by Schizophyllum commune in a captive cheetah (Acinonyx jubatus).

We describe for the first time the diagnosis of Schizophyllum commune infection in a captive cheetah. Eosinophilic plasmacytic conjunctivitis was detected histopathologically in a biopsy specimen. Both a second surgical specimen and drainage fluid from a gingival mass and fistula contained fungal hyphae in giant cells with granulomatous inflammation. Allergic S. commune mycosis was suspected at this point. A monokaryotic isolate was characterized morphologically, and then identified genetically. Treatment with itraconazole and pimaricin was effective.

Premotor Potential Study for Diagnosis of Carpal Tunnel Syndrome.

INTRODUCTION: The second lumbrical-interossei latency difference test (2LINT) is used frequently for electrodiagnosis of carpal tunnel syndrome (CTS). A premotor potential observed with 2LINT has been identified as a median-nerve sensory nerve action potential. We evaluated the utility of the premotor potential latency analysis (i.e., premotor potential study; PPS) for CTS electrodiagnosis. METHODS: Sensitivity, specificity, and percentage "no evoked response" (%NER) values were compared prospectively among PPS, median-nerve sensory nerve-conduction studies (NCSs) for digits 1, 2, and 4, and palmar mixed NCS. RESULTS: Sixty-four healthy control hands and 104 hands with CTS were enrolled in this study. PPS sensitivity was superior to other sensory/mixed NCSs (75% vs. 42%-62%). All NCS specificities were acceptable (95%-97%). The %NER of PPS was lower than that of other NCSs (13% vs. 25%-44%). CONCLUSION: Premotor potential could be evoked in more CTS hands and was the most sensitive among median-nerve sensory and mixed NCSs. Therefore, we could use the 2LINT with PPS as median and ulnar motor NCS as well as median sensory NCS.

What is the most sensitive test for diagnosing carpal tunnel syndrome?

OBJECTIVE: To compare sensitivities between 7 principal nerve conduction studies (NCS) for diagnosing carpal tunnel syndrome (CTS). METHOD: In 104 CTS and 64 control hands, following "Standard" NCSs were examined simultaneously: (1) Median sensory NCS; (2) segmental wrist-palm sensory NCS; (3) 4th digit latency difference; (4) 1st digit latency difference and (5) palmar mixed nerve latency difference. As "Guideline" and "Option" NCSs, we also examined: (6) Median motor distal latency and (7) second lumbrical-interossei latency difference (2LILD). Forty-nine CTS hands were divided into a milder subgroup only if action potentials could be recorded using all tests applied; that is, those with any absent potentials were excluded from the subgroup. Sensitivities and specificities were compared to each other. RESULTS: In all CTS hands, the sensitivity of test (1), (2), (3), (4), (5), (6) and (7) was 83, 87, 92, 90, 90, 70 and 92%, respectively. In the milder subgroup, it was 67, 78, 84, 82, 84, 43, and 84% in the same order. There was no statistical difference between Standard tests and 2LILD. Specificities of all tests were over 95%. CONCLUSIONS: All "Standard" tests and 2LILD have high comparable sensitivities. Therefore, 2LILD should be recommended as "Standard" NCS detecting CTS.

Safe venepuncture techniques using a vacuum tube system.

The purpose of this study was to determine safe techniques of performing blood collection using an evacuated tube system, particularly with regard to manipulation of the equipment and at the puncture site. Careful observation of the procedure was used to collect data for evaluating the various venepuncture techniques. Nurses were digitally videotaped performing simulated venepuncture. A self-administered questionnaire and unstructured observation of a videotaped recording were evaluated, and valid responses were analyzed from participants who performed venepuncture using various techniques. The participants who changed hands during the procedure were older than those who did not change hands. Needle movements during puncture and insertion, including rotation and insertion in a wave-like trajectory, were observed. Appropriate training, including recommendations for maintaining the stability of the needle tip, is important to ensure safety when performing venepuncture. Movement of the needle should not place too much pressure on the puncture site.

Clarification of the characteristics of needle-tip movement during vacuum venipuncture to improve safety.

BACKGROUND: Complications resulting from venipuncture include vein and nerve damage, hematoma, and neuropathic pain. Although the basic procedures are understood, few analyses of actual data exist. It is important to improve the safety standards of this technique during venipuncture. This study aimed to obtain data on actual needle movement during vacuum venipuncture in order to develop appropriate educational procedures. METHODS: Six experienced nurses were recruited to collect blood samples from 64 subjects. These procedures were recorded using a digital camera. Software was then used to track and analyze motion without the use of a marker in order to maintain the sterility of the needle. Movement along the X- and Y-axes during blood sampling was examined. RESULTS: Approximately 2.5 cm of the needle was inserted into the body, of which 6 mm resulted from advancing or moving the needle following puncture. The mean calculated puncture angle was 15.2°. Given the hazards posed by attaching and removing the blood collection tube, as well as by manipulating the needle to fix its position, the needle became unstable whether it was fixed or not fixed. CONCLUSION: This study examined venipuncture procedures and showed that the method was influenced by increased needle movement. Focusing on skills for puncturing the skin, inserting the needle into the vein, and changing hands while being conscious of needle-tip stability may be essential for improving the safety of venipuncture.

Vacuum-venipuncture skills: time required and importance of tube order.

BACKGROUND: The purpose of this study was to assess specific vacuum-venipuncture skills and the influence of the time involved in skin puncture and blood collection. METHODS: Thirty subjects undergoing venipuncture in which video analysis was possible were included. These procedures were carried out by four nurses and recorded with a digital camera. Venipuncture skills classified by our observations were delineated on the basis of frame-by-frame video images, and a graph of x and y coordinates was created. RESULTS: With the first blood-collection tube, strong blood flow required the practitioner to push the tube back in to compensate for the strong repulsive force in approximately 46% of cases. By the third blood-collection tube, the blood flow had weakened; therefore, the tube was moved up and down. In cases that required a second venipuncture, the tube was already pierced, so the time required to fill it to 5 mL was significantly longer. CONCLUSION: Hand movement of the practitioner is adjusted according to blood flow. Reflex movement in response to strong blood flow may increase the risk of pushing the needle through the vein with excessive force. The time required to fill the tube varies among nurses, tube order, and level of venipuncture skills.

Premotor potential study in carpal tunnel syndrome.

INTRODUCTION: Premotor potentials (PMPs) precede compound muscle action potentials evoked from the second lumbrical muscle after median nerve stimulation. Although PMP has been identified as a median sensory nerve action potential, few reports have documented the significance of PMP parameters for diagnosing carpal tunnel syndrome (CTS). METHODS: We investigated the relationships between PMP parameters and results of 6 standard median nerve conduction studies in 74 CTS hands. RESULTS: Significant correlations were noted in all comparisons. PMP conduction velocity was strongly correlated with the sensory conduction velocity between wrist and digit 2 (r(2) = 0.91). Moreover, PMP parameters were significantly correlated with neurophysiological severity of CTS. CONCLUSION: Measuring PMP parameters with a second lumbrical-interosseous study may be useful for diagnosing CTS.

Health behavior of elderly people engaged in agriculture in conjunction with information communication technology.

The aim of this study is to clarify the health behavior of elderly people engaged in agriculture and information communication technology (ICT). The participants were 61 people engaged in agriculture in conjunction with ICT systems (group A), and 49 people not engaged in this (group B) from among the people aged 65 years or over in village C, both living located in a mountain areas. Data were collected from August 2009 to June 2011 in two stages: interviews to members of group A through home visits, and a group survey of groups A and B through questionnaires. The results of the study were as follows: 1) members of group A lived with feelings of attachment to the land to which they were accustomed and showed gratitude to their ancestors; 2) in group A, the desire of participants to continue their life was sufficient motivation to look after their own health and maintain independence; and 3) they provided a new challenge and a sense of achievement. The results suggest that the health behavior in group A was behavior adopted voluntarily in order to maintain an independent lifestyle supported by working, and it is likely to be linked to the preservation of health.

Attitude to extended use and long-term storage of newborn screening blood spots in Japan.

BACKGROUND: Residual dried blood spots (DBS) remaining after routine newborn screening (NBS) tests are candidate specimens for extended uses such as quality assurance and the development of new technology. A trial of NBS using tandem mass-spectrometry was launched in 2004 in Japan. The aim of the present study was to analyze the attitudes of the public, patient families, and medical professionals toward the extended use and long-term storage of residual DBS, and to construct a standardized informational brochure. METHODS: A questionnaire was sent to randomly selected members of the public, members of the Japanese Phenylketonuria (PKU) Association, medical staff of a general hospital, staff of a children's hospital, obstetricians and gynecologists, pediatricians and NBS personnel. Associated responses, which were given in a free comment format, were analyzed by text mining. RESULTS: The awareness ratio of NBS was low in the public (26.6%), but despite this, when a brief explanatory note on NBS was provided, 71.7% of them recognized the necessity of NBS. They were less positive than medical professionals and PKU patient families regarding the extended use of DBS for forensic investigation, for the study of health problems, or long-term storage of residual DBS, regardless of whether these factors affected them personally or not. Among the medical professionals, obstetricians and pediatricians exhibited a higher ratio of negative responses toward the extended use and long-term storage of DBS than others. CONCLUSION: The general public is more conservative than PKU patients and their families or medical professionals about the extended use or long-term storage of residual DBS. Presentation to the public, particularly to couples of childbearing age, of appropriate explanatory information on NBS itself, or the extended use or long-term storage of residual DBS, is recommended.

Paternal transmission and slow elimination of mutant alleles associated with late-onset ornithine transcarbamylase deficiency in male patients.

In ten families with late-onset ornithine transcarbamylase (OTC) deficiency in male patients, three mutant alleles-R40H, R277W, and Y55D-were identified. In a total of 20 informative parent-offspring pairs, father-to-daughter transmission and mother-to-offspring transmission occurred in five (25%) and 15 (75%), respectively, indicating that paternal transmission contributes substantially to the pool of these mutant alleles. Relative reproductive fitness of males and females carrying the mutant alleles was calculated to be 0.49 and 0.89, respectively. Comparison of the life span of the mutant alleles, estimated on the basis of these fitness values with those associated with classic phenotype (neonatal onset) in which reproductive fitness of male patients was nil, revealed that mutant alleles associated with the late-onset phenotype were eliminated more slowly. This would allow the late-onset phenotype mutant alleles to be retained more frequently in a population than those associated with classic phenotype. Although heterozygous females carrying the late-onset phenotype mutant alleles were generally asymptomatic, one female carrying the R40H allele died after a hyperammonemic episode at the age of 18 years. Such heterozygous females should be alerted to possible hyperammonemic crisis.

Roles of specific cytokines in bone remodeling and hematopoiesis in Gaucher disease.

BACKGROUND: Gaucher disease type 1 and type 3 are characterized by bone disease and hematological symptoms. It is known that monocyte/macrophage lineage is activated in Gaucher disease, and accordingly certain cytokines are elevated in blood. The aim of the present study was to explore the possible relationships between cytokines and bone remodeling and hematological abnormalities in this disease. METHODS: The concentrations of seven cytokines and two related proteins were measured in patients with Gaucher disease type 1 and type 3 (n= 8; age range, 2-50 years) who had received enzyme replacement therapy. RESULTS: Concentrations of interleukin-18 and transforming growth factor-beta1 were elevated in patients of all clinical types. Elevation of these cytokines in Gaucher disease has not been previously reported. Analysis of correlation among cytokines and bone-turnover markers showed that interleukin-18 concentration was correlated with each of two bone formation markers of bone-specific alkaline phosphatase activity and osteocalcin concentration, whereas macrophage colony-stimulating factor concentration correlated with the bone absorption marker of N-telopeptide to helix in urine. Concentrations of macrophage colony-stimulating factor and tumor necrosis factor-alpha were inversely correlated with hemoglobin concentration. CONCLUSIONS: Interleukin-18 and monocyte macrophage colony-stimulating factor are cytokines mainly involved in the mechanism of bone disease, while macrophage colony-stimulating factor and tumor necrosis factor-alpha may play a role in the development of hematological abnormalities in Gaucher disease.

[Survey on the current status of patients with Parkinson's disease: their lives with in-home care and the services].

OBJECTIVE: The objective was to conduct a survey to examine what support is necessary for patients with Parkinson's Disease (PD) given in-home care in Japan and to determine the current status of care service utilization. In 2004, a questionnaire survey was conducted on the Tokyo chapter members of the Japan PD METHODS: Association and the results were compared with those from the 1995 survey performed on subjects from the same association. In the 1995 survey, half of the association members of the chapter were selected via random systematic sampling. In the 2004 survey, the questionnaire was mailed with a newsletter to all the association members of the chapter. The individuals returned their questionnaires by postal mail. The collection rates were 52.9% in 1995 and 21.3% in 2004. In both surveys, the mean age of RESULTS: the participants was 69.0 years old. The respondents in the 2004 survey had a higher severity of disease and a larger percentage answered that they had predominant symptoms and difficulties with daily life. Regarding participation in various activities, opportunities to work had decreased, but the possibility of meeting people other than at work and to engage in hobbies and relax had increased. Regarding sources of information, decrease was noted for public health nurses and increase for magazines. There was an increase in the number of people who were told that their problem was psychological at their initial diagnosis. 58.2% of the respondents in the 2004 survey received approval for long-term care insurance, and 37.3% of these reported that they their symptoms were more severe than the level for which they were approved. 7.5% of the respondents answered that their condition had worsened after admission to a nursing facility. CONCLUSION: The results of this 2004 survey have limitations and might not be characteristic of all PD patients. However, the respondents answered that their severity of disease was high and their difficulties increased, despite increase in opportunities to enjoy hobbies and to relax. Clearly, some patients feel that their condition is more severe than the level recognized by the primary nursing care authorities, with some considering that their conditions worsened after receipt of services. Understanding the characteristics of PD, provision of services appropriate to patients' symptoms, and ways of incorporating rehabilitation in patients' daily lives appear to be increasingly necessary. Information support is necessary to understand how best to provide psychological support for PD patients.

A case with acute quadriplegic myopathy following intensive care for idiopathic interstitial pneumonia.

We reported a patient who developed acute quadriplegic myopathy (AQM) following treatment with a combination of high-dose steroid and nondepolarizing blocking agent for idiopathic interstitial pneumonia (IIP). Few cases of AQM with IIP have been reported in the literature. The HP progressed rapidly in our patient, but the high-dose steroid therapy was effective. The rehabilitative intervention comprised of passive range-of-motion exercise, functional training, and muscle strengthening. After the initial presentation with severe weakness, the AQM gradually improved and the patient regained full physical function in 8 months. The clinical course was almost identical to that of AQM patients with other lung diseases. Though unlikely to influence the improvement of muscle weakness in AQM patients, the lung diseases associated with AQM may require specific consideration in determining suitable rehabilitation programs and observing patients before and after full recovery from dysmobility.