Burst spinal cord stimulation for pain and motor function in Parkinson's disease: A case series.

INTRODUCTION: Spinal cord stimulation (SCS) is an established strategy for pain reduction used in whole world including Japan to treat chronic intractable pain. Pain is a frequent comorbidity of Parkinson's disease (PD), leading to poorer quality of life. SCS has been reported to effectively reduce pain in PD and may also improve motor function, but most studies have employed the modality of tonic stimulation. As such, the effects of SCS using the newly developed paradigm of burst stimulation in PD remain relatively unexplored. METHODS: This case series reviewed PD patients who underwent SCS using BurstDR stimulation to treat intractable lower back pain (LBP). Pain and motor outcomes were assessed before and at several timepoints after implantation over a 24-week observation period. RESULTS: Pain indices (visual analogue scale [VAS] and short-form McGill Pain Questionnaire 2 [SF-MPQ-2] scores) improved in nearly all patients. Improvements were especially notable in the dimension of affective pain (SF-MPQ-2). Functional motor improvements were evident in the Unified Parkinson's Disease Rating Scale (UPDRS), especially walking-related items, and timed-up-and-go (TUG) test performance, which generally persisted through week 24 of observation. CONCLUSION: Burst SCS improved pain (especially the affective component) in PD patients with LBP, with effects generally lasting for at least 24 weeks. Neither paresthesia nor obvious adverse events were experienced in any case. Motor symptoms as scored of UPDRS Part III had the trends of improvement in lower limb akinesia at week 24 and gait at week 4. These findings suggest that burst SCS may be an effective treatment option for LBP and may be influenced to gait-related motor symptoms in PD.

Characteristics of facial expression recognition ability in patients with Lewy body disease.

BACKGROUND: The facial expression of medical staff has been known to greatly affect the psychological state of patients, making them feel uneasy or conversely, cheering them up. By clarifying the characteristics of facial expression recognition ability in patients with Lewy body disease, the aim of this study is to examine points to facilitate smooth communication between caregivers and patients with the disease whose cognitive function has deteriorated. METHODS: During the period from March 2016 to July 2017, we examined the characteristics of recognition of the six facial expressions of "happiness," "sadness," "fear," "anger," "surprise," and "disgust" for 107 people aged 60 years or more, both outpatient and inpatient, who hospital specialists had diagnosed with Lewy body diseases of Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies. Based on facial expression recognition test results, we classified them by cluster analysis and clarified features of each type. RESULTS: In patients with Lewy body disease, happiness was kept unaffected by aging, age of onset, duration of the disease, cognitive function, and apathy; however, recognizing the facial expression of fear was difficult. In addition, due to aging, cognitive decline, and apathy, the facial expression recognition ability for sadness and anger decreased. In particular, cognitive decline reduced recognition of all of the facial expressions except for happiness. The test accuracy rates were classified into three types using the cluster analysis: "stable type," "mixed type," and "reduced type". In the "reduced type", the overall facial recognition ability declined except happiness, and in the mixed type, recognition ability of anger particularly declined. CONCLUSION: There were several facial expressions that the Lewy body disease patients were unable to accurately identify. Caregivers are recommended to make an effort to compensate for such situations with language or body contact, etc., as a way to convey correct feeling to the patients of each type.

Molecular detection of protozoan parasites infecting Apis mellifera colonies in Japan.

The role of protozoan parasites in honey bee health and distribution in the world is not well understood. Therefore, we carried out a molecular survey for the presence of Crithidia mellificae and Apicystis bombi in the colonies of both non-native Apis mellifera and native Apis cerana japonica in Japan. We found that A. mellifera, but not A. c. japonica, colonies are parasitized with C. mellificae and A. bombi. Their absence in A. c. japonica colonies indicates that A. mellifera is their native host. Nevertheless, the prevalence in A. mellifera colonies is low compared with other pathogens such as viruses and Nosema microsporidia. Japanese C. mellificae isolates share well-conserved nuclear-encoded gene sequences with Swiss and US isolates. We have found two Japanese haplotypes (A and B) with two nucleotide differences in the kinetoplast-encoded cytochrome b sequence. The haplotype A is identical to Swiss isolate. These results demonstrate that C. mellificae and A. bombi distribute in Asia, Oceania, Europe, and South and North Americas.

Molecular identification of chronic bee paralysis virus infection in Apis mellifera colonies in Japan.

Chronic bee paralysis virus (CBPV) infection causes chronic paralysis and loss of workers in honey bee colonies around the world. Although CBPV shows a worldwide distribution, it had not been molecularly detected in Japan. Our investigation of Apis mellifera and Apis cerana japonica colonies with RT-PCR has revealed CBPV infection in A. mellifera but not A. c. japonica colonies in Japan. The prevalence of CBPV is low compared with that of other viruses: deformed wing virus (DWV), black queen cell virus (BQCV), Israel acute paralysis virus (IAPV), and sac brood virus (SBV), previously reported in Japan. Because of its low prevalence (5.6%) in A. mellifera colonies, the incidence of colony losses by CBPV infection must be sporadic in Japan. The presence of the (-) strand RNA in dying workers suggests that CBPV infection and replication may contribute to their symptoms. Phylogenetic analysis demonstrates a geographic separation of Japanese isolates from European, Uruguayan, and mainland US isolates. The lack of major exchange of honey bees between Europe/mainland US and Japan for the recent 26 years (1985-2010) may have resulted in the geographic separation of Japanese CBPV isolates.

Infestation of Japanese native honey bees by tracheal mite and virus from non-native European honey bees in Japan.

Invasion of alien species has been shown to cause detrimental effects on habitats of native species. Insect pollinators represent such examples; the introduction of commercial bumble bee species for crop pollination has resulted in competition for an ecological niche with native species, genetic disturbance caused by mating with native species, and pathogen spillover to native species. The European honey bee, Apis mellifera, was first introduced into Japan for apiculture in 1877, and queen bees have been imported from several countries for many years. However, its effects on Japanese native honey bee, Apis cerana japonica, have never been addressed. We thus conducted the survey of honey bee viruses and Acarapis mites using both A. mellifera and A. c. japonica colonies to examine their infestation in native and non-native honey bee species in Japan. Honey bee viruses, Deformed wing virus (DWV), Black queen cell virus (BQCV), Israeli acute paralysis virus (IAPV), and Sacbrood virus (SBV), were found in both A. mellifera and A. c. japonica colonies; however, the infection frequency of viruses in A. c. japonica was lower than that in A. mellifera colonies. Based on the phylogenies of DWV, BQCV, and SBV isolates from A. mellifera and A. c. japonica, DWV and BQCV may infect both honey bee species; meanwhile, SBV has a clear species barrier. For the first time in Japan, tracheal mite (Acarapis woodi) was specifically found in the dead honey bees from collapsing A. c. japonica colonies. This paper thus provides further evidence that tracheal-mite-infested honey bee colonies can die during cool winters with no other disease present. These results demonstrate the infestation of native honey bees by parasite and pathogens of non-native honey bees that are traded globally.

PCR-based detection of a tracheal mite of the honey bee Acarapis woodi.

The effects of the tracheal mite Acarapis woodi on the health of honey bees have been neglected since the prevalence of Varroa mites to Apis mellifera colonies. However, tracheal mite infestation of honey bee colonies still occurs worldwide and could impose negative impact on apiculture. The detection of A. woodi requires the dissection of honey bees followed by microscopic observation of the tracheal sacs. We thus developed PCR methods to detect A. woodi. These methods facilitate rapid and sensitive detection of A. woodi in many honey bee samples for epidemiologic surveys.

The habitat disruption induces immune-suppression and oxidative stress in honey bees.

The honey bee is a major insect used for pollination of many commercial crops worldwide. Although the use of honey bees for pollination can disrupt the habitat, the effects on their physiology have never been determined. Recently, honey bee colonies have often collapsed when introduced in greenhouses for pollination in Japan. Thus, suppressing colony collapses and maintaining the number of worker bees in the colonies is essential for successful long-term pollination in greenhouses and recycling of honey bee colonies. To understand the physiological states of honey bees used for long-term pollination in greenhouses, we characterized their gene expression profiles by microarray. We found that the greenhouse environment changes the gene expression profiles and induces immune-suppression and oxidative stress in honey bees. In fact, the increase of the number of Nosema microsporidia and protein carbonyl content was observed in honey bees during pollination in greenhouses. Thus, honey bee colonies are likely to collapse during pollination in greenhouses when heavily infested with pathogens. Degradation of honey bee habitat by changing the outside environment of the colony, during pollination services for example, imposes negative impacts on honey bees. Thus, worldwide use of honey bees for crop pollination in general could be one of reasons for the decline of managed honey bee colonies.