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.

Kinetic analysis of tandem gait on a sine-wave-shaped walkway.

[Purpose] The purpose of this study was to ascertain the kinetic characteristics on a horizontal plane, including knee joint rotation, when performing tandem gait on a sine-wave walkway. [Participants and Methods] The participants were 10 healthy adults. The movement task included tandem gait on a sine-wave walkway. The instruments used were an electromyograph and a three-dimensional motion analysis system. Regarding data analysis, we determined the knee joint rotation angle and muscle activity of the biceps femoris and semitendinosus muscle. [Results] The knee joint rotation angle range was 48.1 ± 6.7°. Two strategies were confirmed with regard to the direction of knee joint rotation: a case in which the agonist muscle acts actively and a case in which the antagonist muscle acts passively. [Conclusion] It has been suggested that the knee joint rotational angle and muscular activity of the rotator muscle group are important for tandem gait on a sine-wave-shaped walking path.

Motor coordination during body rotation while standing in healthy participants.

[Purpose] To describe the nature of multi-joint motor coordination during body rotation while in the standing position. [Participants and Methods] The participants were 22 healthy adults with no visual problems or history of diseases that could compromise their ability to execute body rotation. The position facing forward in an upright standing position was defined as 0°, and targets were placed at the following five points on concentric circles: 30°, 60°, 90°, 120°, and 150°. The participants always turned to the right. A three-dimensional motion analyzer consisting of six infrared cameras was used to measure the spatial coordinates of the infrared reflective markers. [Results] A main effect was found for all body segments. For all the target angles, the start of movement was approximately equal, and the angular change of the craniocervical joint was the largest. A nonlinear relationship was observed between the craniocervical and thoracolumbar joints for all target angles. However, a linear relationship was found between the thoracolumbar and pelvic joints. [Conclusion] The results of this study demonstrate that various regions such as the craniocervical and thoracolumbar junctions and the pelvis coordinate during such move to achieve optimal locomotive patterns.

Frequency analysis of the center of pressure in tandem stance in community-dwelling elderly.

[Purpose] The present study aimed to clarify the effects of balance control on the pronation and supination movements of the talocrural joint in community-dwelling elderly women by conducting a frequency analysis of the center of pressure during tandem stance. [Subjects and Methods] The study participants were 18 subjects who maintained tandem stance for 20 s and 11 who had difficulty maintaining tandem stance for 20 s. The frequency-power spectra were computed and classified into three frequency bands. Each power spectral value was divided by the sum of the power spectral values to obtain the %power. [Results] Significant differences in high-frequency band %power value for the center of pressure in both the mediolateral and anteroposterior components were evident between the groups. [Conclusion] A markedly significant difference was observed, particularly in high frequency band %power, depending on balance control. The present findings indicated that elderly participants with diminished balance control had difficulty with rapid adjustment centered on the ankles, suggesting that rapid joint movement involving interlimb coordination centered on the ankles is required to maintain tandem stance.

Kinematic analysis of tandem gait on a sine wave walkway.

[Purpose] The purpose of this study was to ascertain the kinematic characteristics on a horizontal plane, including knee joint rotation, when walking with a tandem gait on a sine wave walkway. [Subjects and Methods] Eighteen healthy adults were enrolled as subjects in this study. They walked with a tandem gait on a sine wave walkway. A three-dimensional motion analysis system was used to record data and calculate the trunk, hip joint, and knee joint rotation angles. [Results] The rotation angle ranges for the trunk, hip joint, and knee joint were 23.3°, 53.3°, and 47.3°, respectively. The trunk generally rotated towards the direction of movement, and when turning left using the left leg as the pivot, the hip joint was internally rotated and the knee joint was externally rotated. In contrast, when making a directional change to the right using the left leg as the pivot, the hip joint was externally rotated and the knee joint was internally rotated. [Conclusion] Through tandem gait analysis on a sine wave walkway, knee joint rotation was found to be important in changes of direction.

Postural optimization during functional reach while kneeling and standing.

[Purpose] The purpose of the present study was to examine the validity of functional reach models by comparing actual values with estimated values. [Subjects and Methods] Twenty-eight volunteers were included in this study (male: 14, female: 14, age: 21 ± 1 years, height: 166.8 ± 9.0 cm, and body mass: 60.1 ± 8.5 kg). The maximum forward fingertip position and joint angles were measured using the original equipment. In addition, the maximum forward fingertip position, shoulder joint angle, and knee or ankle joint angle were estimated using the functional reach model. [Results] The correlation coefficients between actual data and estimated data for the maximum forward fingertip position, shoulder joint angle, and ankle joint angle while standing were 0.93, 0.83, and 0.73, respectively. The correlation coefficients between actual data and estimated data for the maximum forward fingertip position, shoulder joint angle, and knee joint angle while kneeling were 0.86, 0.81, and 0.72, respectively. [Conclusion] The validity of both functional reach models in estimating optimal posture was confirmed. Therefore, the functional reach model is useful for evaluation of postural control and optimal postural control exercises.

The role of interaction torque and muscle torque in the control of downward squatting.

[Purpose] The purposes of this study were first to analyze the multijoint dynamics of downward squatting, and to examine the contribution of interaction torque and muscle torque to net torque, and second, to examine mechanisms of movement control. [Subjects] The subjects were 31 healthy men with a mean age of 21.0 ± 1.2 years (range, 19-24 years). [Methods] Squatting tasks with the trunk in two positions, an erect and anterior tilt position, were performed by the subjects. Net, interaction, muscle, and gravity torque were calculated according to the Lagrange equation using 3D tracking data. [Results] The contribution ratio of interaction torque to net torque was approximately 90%, irrespective of the joint and task. In contrast, muscle torque showed complicated behavior to compensate for gravity torque. A combined muscle and gravity torque profile showed flexion or dorsiflexion immediately after the initiation of the movement, and it later changed to extension or plantar flexion. [Conclusion] The torque that contributes almost exclusively to the net torque was interaction torque. The combination of muscle and gravity torque at the knee joint and the hip joint is important for movement control, independent of the starting position.

The relationship between energy cost and the center of gravity trajectory during sit-to-stand motion.

[Purpose] The purpose of this study was to examine the relationship between jerk cost and the formation of the center of gravity trajectory during sit-to-stand motion with asymmetrical foot placement. [Subjects] Nineteen male volunteers were included (age: 21 ± 1 years). [Methods] The subjects moved from a sitting position to a standing position under two different foot placement conditions: (1) 0 degrees of dorsiflexion on the non-dominant side and 20 degrees of dorsiflexion on the dominant side (P1) and (2) 20 degrees of plantarflexion on the non-dominant side and 20 degrees of dorsiflexion on the dominant side (P2). Two standing conditions were used: (1) natural movement and (2) instructed movement, with instructions to increase weight bearing on the non-dominant side. The center of gravity trajectory and its jerk cost were calculated at each axis: front and back (jerk-x), right and left (jerk-y), and vertical (jerk-z). [Results] Jerk-x and jerk-y were significantly larger during instructed movement than natural movement in both P1 and P2. Jerk-z was not significantly different between instructed and natural movement in P1 or P2. [Conclusion] These results indicate that energy cost influences the formation of the center of gravity trajectory during sit-to-stand motion with asymmetrical foot placement.

[Streptococcus pneumoniae meningitis treated successfully with polymyxin B-immobilized fiber therapy: a case report].

A-61-year old man was admitted to our hospital with fever and severe disturbance of consciousness. He was diagnosed with Streptococcus pneumoniae meningitis on the basis of cerebrospinal fluid (CSF) analysis and urinary antigen detection by immunochromatography. Although he was treated with dexamethasone and antibiotics, his general status worsened as systemic inflammatory response syndrome (SIRS), disseminated intravascular coagulation (DIC), and status epileptics developed. Following treatment with polymyxin B-immobilized fiber therapy (PMX), which can also absorb bacteria-derived toxic substances, he recovered from DIC and SIRS, and disturbance of consciousness improved immediately. In addition, the concentration of several CSF cytokines--IL-1, IL-2, and TNF-α--was decreased. The present case suggests that PMX is a good option for severe bacterial meningitis.

Spread to the dorsal ulnar cutaneous branch: a pitfall during the routine antidromic sensory nerve conduction study of the ulnar nerve.

OBJECTIVE: To document the incidence and effects of a previously unreported pitfall during routine antidromic sensory nerve conduction study (SCS) of the ulnar nerve: the spread of the wrist stimulation to the dorsal ulnar cutaneous (DUC) branch. METHODS: The subjects consisted of 20 healthy volunteers. An antidromic sensory nerve action potential (SNAP) was recorded over the proximal interphalangeal joint of the little finger, and the DUC response was monitored over the dorsum of hand to check for the occurrence of this spread. RESULTS: The spread occurred in all subjects, which caused a 4-87% increase in the SNAP amplitude. The likelihood that this spread may occur during routine SCS varied among the subjects, and also within an individual subject depending on minute shifts of the stimulating site. Selective stimulation of the ulnar main trunk up to maximal intensity without spread to the DUC was not achieved despite every effort in two subjects. CONCLUSIONS: This spread phenomenon may occur frequently during routine antidromic SCS, but would not be recognized without monitoring the DUC response. SIGNIFICANCE: This pitfall may interfere with the reproducibility of the SNAP amplitude, and also with the diagnosis of ulnar neuropathy at the wrist.

A-waves in Guillain-Barré syndrome: correlation with electrophysiological subtypes and antiganglioside antibodies.

OBJECTIVE: To investigate the relationship of A-waves with conventional electrophysiological subtypes of Guillain-Barré syndrome (GBS), as well as with anti-ganglioside antibodies. METHODS: The subjects consisted of 30GBS patients who were classified into acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy, and unclassified based on the results of nerve conduction studies. "Abundant A-waves" were defined for the upper-limb nerves (median and ulnar nerves) using receiver-operator characteristic curves. The presence or absence of IgG anti-ganglioside antibodies was also noted. RESULTS: Abundant A-waves at weeks 3-6 from onset were observed in 64% of the 14 AIDP patients and 0% of 16 non-AIDP patients, and in 60% of 15 antibody-negative patients and 0% of 15 antibody-positive patients. In the earlier period, this relationship was less clear. The correlation between the conventional electrophysiological subtypes and antibodies was present, but was much weaker. CONCLUSIONS: Abundant A-waves in GBS after the acute phase were strongly associated with demyelination that was not mediated by antiganglioside antibodies, possibly through the mechanism of proximal re-excitation induced by electrical inhomogeneities due to segmental demyelination. SIGNIFICANCE: Abundant A-waves are promising as a novel reliable marker of demyelination.

Siblings with spaced arches treated with and without partial glossectomy.

Macroglossia, or enlarged tongue, is thought to be an etiological factor in open bite, bimaxillary protrusion, and dental arch spacing, and it might cause instability after orthodontic treatment. Partial glossectomy to reduce tongue size might be a useful method of solving these problems. In this report, we describe orthodontic treatment of 2 siblings with enlarged tongues and arch-space problems. The sister, whose tongue was larger and spacing problem more severe, was treated with a partial glossectomy; her brother refused surgery and was treated with a tongue-crib appliance. Stability after orthodontic treatment was evaluated.

Oral rehabilitation of an orthodontic patient with cleft lip and palate and hypodontia using secondary bone grafting, osseo-integrated implants, and prosthetic treatment.

OBJECTIVE: Complete skeletal and dental reconstruction of the anterior maxilla is of great importance to patients with cleft lip and palate. Accordingly, osseo-integrated implants have been utilized for dental reconstruction after secondary bone grafting. In this report, the orthodontic management of a patient with unilateral cleft lip and plate with associated hypodontia is described. The patient was treated with comprehensive orthodontic treatment in addition to secondary bone grafting, and dental reconstruction was achieved with a combination of osseo-integrated implants and fixed prosthodontic treatment.

Longitudinal evaluation of secondary bone grafting into the alveolar cleft.

OBJECTIVE: To longitudinally evaluate the outcome of secondary bone grafting (SBG) using computed tomograms (CTs) and conventional dental radiographs. SUBJECTS: Nineteen alveolar clefts from 17 patients were used in this study. METHOD: A two-dimensional evaluation of SBG was performed using dental radiographs at 1 year after SBG by assigning scores of 1 to 4 (from very good to poor) based on postoperative marginal bone level on the alveolar side. On the basis of postoperative marginal bone levels on the nasal side, clefts were also assigned to groups with the bony bridge on or above (group I) or below (group II) a horizontal reference line. Three-dimensional evaluation of the SBG was performed on horizontal CT slices with the residual cortical bone (RCB) ratio before SBG (T0) as well as 1.5 (T1), 3 (T2), 6 (T3), and 12 months (T4) after SBG. RESULTS: The RCB ratio at T4 in the group with scores 1 and 2 was significantly smaller than that of score 3. Furthermore, the mean RCB ratio at T4 in group I was significantly smaller than that in group II. Nineteen alveolar clefts were divided into two groups, A and B, based on a cluster analysis of the RCB ratios. Group A showed a continuous decrease in the RCB ratio from T0 to T2, but group B showed a significant decrease only in the period from T0 to T1. CONCLUSION: These results suggested that the RCB ratio might be a useful parameter for evaluation of the bony bridge after SBG.

Prognostic implications of nasal cavity and cleft morphology in secondary bone grafting.

OBJECTIVE: To examine the prognostic significance of the skeletal morphology around the nasal cavity and the alveolar cleft in secondary bone grafting (SBG). DESIGN AND SETTING: Fifty-one alveolar clefts in 41 patients (10 bilateral and 31 unilateral cleft lips and palates) registered in the Tokushima University Dental Hospital were examined in this study. METHOD: Evaluation of the bony bridge after SBG using dental radiographs at 1 year after surgery. The clefts were divided into two groups: group I (54.9%) in which the upper border of the bony bridge was preferably maintained on or above the horizontal reference line (RL) constructed at the level of the root apex of the upper central incisor adjacent to the cleft, and group II (45.1%) in which the bone level was lower than the RL. Presurgical cleft width was determined by the dental radiographs. The cleft/nasal cavity ratio; the value of the cleft width divided by the nasal cavity width on the cleft side, which was analyzed by frontal cephalograms before the SBG; and the cleft/apertura piriformis ratio, the value analyzed by computed tomography, were used. RESULTS AND CONCLUSION: The age, sex, and eruptive stage of the canine teeth at the time of the SBG showed no significant difference between groups. The presurgical cleft width also showed no significant difference between group I (6.6 +/- 3.1 mm) and group II (7.9 +/- 3.3 mm). The cleft/nasal cavity ratio showed a significant difference between groups I and II (0.42 +/- 0.14, 0.75 +/- 0.25; p < .05). Furthermore, the cleft/apertura piriformis ratio also showed a significant difference between groups I and II (0.32 +/- 0.12, 0.65 +/- 0.26; p < .05). These results suggested that measurements of the skeletal morphology around the nasal cavity and alveolar cleft might aid in predicting the stability of the bony bridge after SBG.