Effect of Robot-assisted Rehabilitation to Botulinum Toxin A Injection for Upper Limb Disability in Patients with Chronic Stroke: A Case Series and Systematic Review

Combining single-joint hybrid assistive limb (HAL-SJ) with botulinum toxin A (BTX-A) therapy is novel and has great therapeutic potential for the rehabilitation of stroke patients with upper limb paralysis. The purpose of this observational case series study was to evaluate the effect of BTX-A and HAL-SJ combination therapy on different exoskeleton robots used for treating upper limb paralysis. The HAL-SJ combination received a BTX-A injection followed by HAL-SJ-assisted rehabilitation for 60 min per session, 10 times per week, during 2 weeks of hospitalization. Clinical evaluations to assess motor function, limb functions used during daily activities, and spasticity were performed prior to injection, at 2-week post-treatment intervention, and at the 4-month follow-up visit. The total Fugl-Meyer assessment-upper limb (FMA-UE), proximal FMA-UE, action research arm test (ARAT), Motor Activity Log (MAL), and Disability Assessment Scale (DAS) showed a statistically significant difference, and a large effect size. However, the FMA distal assessment at 2-week post-treatment intervention showed no significant difference and a moderate effect size. The FMA-UE scores of the extracted systematic review articles showed that our design improved upper limb function. The change in the total FMA-UE score in this study showed that, compared to previous reports in the exoskeletal robotic therapy group, our combination therapy had a higher score than five of the seven references. Our results suggest that BTX-A therapy and HAL-SJ combination therapy may improve upper limb function, similar to other treatment methods in the literature.     

Comparison of Gleason grade and score between preoperative biopsy and prostatectomy specimens in prostate cancer

AIM: Although the histopathological findings obtained from biopsy specimens are important for choosing the appropriate management of prostate cancer, there have been some discrepancies in Gleason grade and consequently, score between biopsy and surgical specimens. A comparison of findings between these two kinds of specimens was performed. METHODS: Radical prostatectomy was performed at Asahi General Hospital on 223 cases of T1b-T3 without previous cancer treatment, and the Gleason grade and score of the biopsy and surgical specimens were compared. RESULTS: A 37% coincidence in Gleason score was obtained between biopsy and surgical specimens; coincidence including one digit difference in score was approximately 70%. Upgrading was more than downgrading. Disagreement in secondary grade was greater than that in primary grade. Disagreement in Gleason score was roughly similar among different score items and was not influenced by level of prostate-specific antigen, however, the small volume of the cancer tissues more affected the discrepancy in score. CONCLUSION: The use of biopsy findings is required to be taken into account regarding the discrepancy.     

Longitudinal study on torque transmitted from denture base to an abutment tooth of lower distal-extension removable partial dentures with conus crown telescopic system

The purpose of this study was to make a longitudinal analysis of torque transmitted to a direct abutment tooth of a lower distal-extension removable partial dentures constructed with the conus crown telescopic system. Torque around the vertical and lateral axes of the tooth were measured during chewing of food at the time of insertion of the new dentures to about three months after. The maximal mean value of torque ( Max.MT ) was calculated from the peak level of all chewing strokes at the minimum of the interocclusal distance. The integration values of torque (I) and time (T) from initiation of chewing to swallowing were obtained, then the average value of torque ( Ave.T ) was calculated ( Ave.T = I/T).
The results are summarized as follows: (a) There were no remarkable changes of Max.MT around the both axes; (b) Max.MT around the lateral axis was 7-47 × 10^-3kgm (mean: 25X10^-3kgm) (1kgm = 9.8Nm) in the downward direction and Ave.T around the lateral axis was 6.14 × 10^-3kgmss^-1 (mean: 10 × 10^-3kgm ss^-1) in the downward direction; (c) There were marked differences of Max.MT and Ave.T around the vertical axis between subjects. Max.MT around the vertical axis was less than 24 × 10^-3 kgm and Ave. T around the vertical axis was less than 6 × 10^-3 kgm ss^-1.     

Multiple tiny granulomatous lesions with eosinophils in a patient with smoldering-type adult T-cell leukaemia: The possibility of a new type of bronchioloalveolopathy

We herein describe the first case, to our knowledge, of pulmonary lesions characterized by necrotizing granuloma formation with eosinophils, in a patient with smoldering-type adult T-cell leukaemia. A 74-year-old man, diagnosed with smoldering-type adult T-cell leukaemia 1 year previously, was admitted due to repeated pyrexia and concurrent identification of diffuse small pulmonary nodules. A surgical lung biopsy specimen revealed inflammatory nodular lesions measuring up to 3 mm in size, which contained necrotizing and non-necrotizing granulomas, intraluminar organization and eosinophils, and were of unknown aetiology. The patient's condition, including the radiological findings, improved gradually without any treatment. This case suggests the possibility of a new type of human T-lymphotropic virus type-1 associated bronchioloalveolar disorder.     

Reactive Lymphoreticular Hyperplasia of the Stomach Showing a Submucosal Tumor

Abstract: Reactive lymphoreticular hyperplasia of the stomach has been reported rarely. Furthemore, submucosal tumors of the type found in this condition are rare and only 7 such cases have been reported. A 57-year-old male visited our hospital with his chief complaint being tarry stool. An UGI and endoscopy showed a submucosal tumor with a central depression in the posterior wall of the gastric body. Microscopically and immunohistochemically, lymphoid hyperplasia of the stomach was recognized, but it was very difficult to differentiate the condition from malignant lymphoma. The patient is in good health with no medication 2 years after surgery.     

A Preliminary Report of Phase I and II Study of N4-Behenoyl-1-{beta}-D-arabinofuranosylcytosine (BH-AC) in Patients with Acute Leukemia and Other Malignancies

N⁴-Behenoy1-1-ß-D-arabinofuranosy1cytosine (BH-AC)was administered to 11 patients with acute leukemia and fivepatients with other malignancies in a Phase I and TI clinicaltrial. Among 16 patients, 14 received BH-AC after being refractoryto prior therapies, and two with acute leukemia received BH-ACfor their first remission induction therapy. The starting dose was 1.5mg/kg administered as a single i.v.infusion of three hours. The doses were then escalated up to5.0 mg/kg. No side effects were noted with single i.v. infusions.Daily consecutive infusions of 2.0 mg to 6.0 mg/kg for fourto 21 days resulted in two patients experiencing nausea, twoanorexia and one developing skin eruptions. Significant hematologicaleffects were noted by the daily infusions. One patient withacute myeloblastic leukemia achieved complete remission with5.0 mg/kg BH-AC administered daily for 21 days. BH-AC is active in acute leukemia and may play a role in thecombination regimens for this disease.     

The Effect of Fusaric Acid, Inhibitor of Dopamine β-hydroxylase, on Reaction to Alcohol in Chronic Alcoholics: Clinical Findings

In order to explore the question if dopamine β-hydroxylase inhibitor alone has a disulfiram-like effect on alcohol, fusaric acid, a potent inhibitor of dopamine β-hydroxylase, was administered to 23 gamma alcoholics. The alcohol-test was made twice, prior to administration of fusaric acid and after one week of the treatment. Significant effects of the agent on reaction to alcohol were observed in the symptom of flushing of face, a fall in blood pressure, change of the taste, and feeling of getting drunk. These symptoms were more slight than those of the alcohol-disulfiram reaction. However, it was emphasized that the mechanism of the alcohol-disulfiram reaction is not explained by only a transient hyperacetaldehydemia, but may be also related to the metabolism of both catecholamines and serotonin. Further clinical studies are needed to assess therapeutic use of te compound in the treatment of chronic alcoholism. The fusaric acid was supplied from Banyu Pharmaceutical Co. Ltd. with a favor of Professor Hamao Umezawa, Director of Institute of Biseibutsu Kagaku to meet with the request of one of the authors, Motoi Ogata, M.D.     

Duodenal Adenoma Removed by Endoscopic Polypectomy

Abstract: We report two duodenal adenoma cases treated by endoscopic polypectomy. Case 1, a 59-year-old male, visited our hospital for further examination of a duodenal polyp found elsewhere. X-ray examination revealed a semi-pedunculated polyp with an irregular surface in the second portion of the posterior wall of the duodenum. Case 2, a 68-year-old male, was admitted to our hospital for endoscopic polypectomy of a duodenal polyp. Upper GI series demonstrated a semi-pedunculated round polyp with a shallow central depression. Endoscopic polypectomy was performed for both lesions and the polyps were successfully removed. The resected polyps were 11 × 10 mm and 13 × 12 mm in size, respectively. The polyps were histologically diagnosed as tubulovillous and tubular adenomas, respectively, with no evidence of malignancy. Endoscopic polypectomy provides histological confirmation of adenoma of the gastrointestinal tract, and it is frequently applicable to the duodenum.