Influence of daily activity on changes in physical fitness for people with post-stroke hemiplegia

To investigate the influence of daily activity on changes in the physical fitness of people with post-stroke (cerebrovascular disorders) hemiplegia, we evaluated the follow-up exercise load test of 30 ambulatory male patients with post-stroke hemiplegia. Between the times of the two tests, patients had no special supervised training. They were advised by their physicians to exercise according to the result of an exercise-loading test. We determined peak oxygen uptake and O2 consumption at the ventilatory threshold point. After 9.4 months, the mean peak oxygen uptake improved significantly from 17.7 to 21.1 ml/min/kg, and ventilatory threshold point also improved significantly from 11.4 to 13.6 ml/min/kg. Among the nine subjects who returned to their jobs, subjects who previously went to their offices by public transportation showed more improvement in ventilatory threshold point level than did subjects who previously walked to their offices. Among the 21 subjects who did not return to work, those who exercised regularly (primarily by walking) showed more improvement of peak oxygen uptake level than did subjects who did not exercise regularly. In conclusion, people with hemiplegia who are living in the community can improve their physical fitness without formal supervised training by simply increasing their daily activities.     

Dynamic change and influence of osteoporotic back pain with vertebral fracture on related activities and social participation: evaluating reliability and validity of a newly developed outcome measure

The objective of this study was to record the clinical course of osteoporosis over time in Japanese women. We hypothesized that successful control of acute pain associated with osteoporosis will allow better treatment for health-related problems. To confirm this working hypothesis, we developed the Japan Questionnaire for Osteoporotic Pain (JQ22) to measure health status associated with osteoporosis. We examined the validity and reliability of the JQ22 compared with the current gold standard scale for back pain, the Roland Morris questionnaire (RDQ). A total of 125 women who were more than 65 years old, had an acute back pain episode, and had a fragile vertebral fracture confirmed by X-ray and clinical signs, participated in this study. The psychometric analyses for validity and reliability were tested for the JQ22 and the RDQ. The time course up to 6 weeks was observed by investigating both changes in pain characteristics and its influence on related activities and social participation. Cronbach’s alpha coefficient was 0.979 and 0.919 for the JQ22 and RDQ, respectively. The Akaike Information Criterion (AIC) indicated that the JQ22 items were separated into four domains, which were sequentially arranged at the baseline and subsequently changed. This structure reflected osteoporotic back characteristics covering a range from pain to social activities. The JQ22 was shown to be a valid and reliable scale for patient-based measurement of osteoporotic back pain. It also revealed both changes in pain characteristics and the influence of pain on related activities and participation.     

Correction to: Association of initial prednisolone dose with remission,relapse, and infectious complications in adult‑onset minimal change disease

Clinical and Experimental Nephrology - In the original publication, the author has found few errors. The corrections are given below.     

Facilitation of the soleus stretch reflex induced by electrical excitation of plantar cutaneous afferents located around the heel

Previous studies have demonstrated that plantar cutaneous afferents can adjust motoneuronal excitability, which may contribute significantly to the control of human posture and locomotion. However, the role of plantar cutaneous afferents with respect to their location specificity in modulating the mechanically induced stretch reflex still remains unclear. In the present study, it was hypothesized that electrical stimulation of the ipsilateral heel region of the foot is followed by a modulation of spinal excitability, leading to a facilitation of the soleus motor output. The study was performed to investigate the effect of excitation of plantar cutaneous afferents located around the heel on the soleus stretch reflex. The soleus stretch reflex was evoked by rotating the ankle joint in dorsiflexion direction at two different angular velocities of 50 and 200 degrees s(-1). A conditioning pulse train of non-noxious electrical stimulation was delivered to the plantar surface of the heel at different conditioning test intervals ranging from 5 to 100 ms. Excitation of plantar cutaneous afferents around the heel resulted in a pronounced facilitation of the soleus stretch reflex with magnitude and time course comparable for both velocities. This facilitation was manifested by a significant increase of reflex size for conditioning test intervals from 30 to 70 ms. The observed effect implies a potential functional role of cutaneous afferents in balance control conditions where the ankle is naturally disturbed, e.g., during step reactions to external perturbations.     

Randomized trial of an intensified,multifactorial intervention in patients with advanced-stage diabetic kidney disease: Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT-Japan)

Aims/IntroductionWe evaluated the efficacy of multifactorial intensive treatment (IT) on renal outcomes in patients with type 2 diabetes and advanced‐stage diabetic kidney disease (DKD).Materials and MethodsThe Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT‐Japan) is a multicenter, open‐label, randomized controlled trial with a 5‐year follow‐up period. We randomly assigned 164 patients with advanced‐stage diabetic kidney disease (urinary albumin‐to‐creatinine ratio ≥300 mg/g creatinine, serum creatinine level 1.2–2.5 mg/dL in men and 1.0–2.5 mg/dL in women) to receive either IT or conventional treatment. The primary composite outcome was end‐stage kidney failure, doubling of serum creatinine or death from any cause, which was assessed in the intention‐to‐treat population.ResultsThe IT tended to reduce the risk of primary end‐points as compared with conventional treatment, but the difference between treatment groups did not reach the statistically significant level (hazard ratio 0.69, 95% confidence interval 0.43–1.11; P = 0.13). Meanwhile, the decrease in serum low‐density lipoprotein cholesterol level and the use of statin were significantly associated with the decrease in primary outcome (hazard ratio 1.14; 95% confidence interval 1.05–1.23, P < 0.001 and hazard ratio 0.53, 95% confidence interval 0.28–0.998, P < 0.05, respectively). The incidence of adverse events was not different between treatment groups.ConclusionsThe risk of kidney events tended to decrease by IT, although it was not statistically significant. Lipid control using statin was associated with a lower risk of adverse kidney events. Further follow‐up study might show the effect of IT in patients with advanced diabetic kidney disease.     

Characterization and use of monoclonal antibodies directed against human erythropoietin that recognize different antigenic determinants

We have established four hybridoma cells that produce monoclonal antibodies (MoAbs) R2, R4, R6, and R12 directed toward recombinant human erythropoietin (rHuEPO). MoAbs R2, R4, and R6 bound to EPO with high affinities (kd = approximately 2, 4, and 1 nmol/L, respectively) but MoAb R12 had a low affinity (240 nmol/L). These antibodies inhibited the biological activity of rHuEPO and EPOs from humans, rats, mice, and rabbits. This inhibition was due to the blocking of EPO binding to the target cells. The fully deglycosylated rHuEPO bound to the MoAbs, indicating that they recognized peptide sequences of the antigen but not the carbohydrates attached to the antigen. An immunosorbent column with the immobilized MoAb R2 was effective for the rapid purification of EPO. MoAb R6 bound to EPO at a site(s) different from those to which other MoAbs bound. Based on this finding, a sensitive and rapid enzyme-linked immunosorbent assay of EPO, in which EPO was sandwiched between two MoAbs (R2 and R6), was developed. The assay measured plasma levels of EPO as low as 5 mU/mL within several hours.     

Properties of cytoplasmic mutants of Saccharomyces cerevisiae with specific lesions in cytochrome oxidase.

Two mutants with specific defects in cytochrome c oxidase (ferrocytochrome c:oxygen oxidoreductase; EC 1.9.3.1) have been isolated from cultures of Saccharomyces cerevisiae exposed to the mutagens ethyl-methane sulfonate and Mn++. The mutations have been shown to be extranuclear by two criteria. The phenotype persists in diploids formed by a cross with a p-o strain of yeast of the opposite mating type. Tetrad analysis indicates a non-Mendelian segregation (4:0 and 0:4) of the mutations. Both mutants show a total absence of cytochrome oxidase activity and of spectral cytochromes a and as. One of the mutants has been shown to be missing a polypeptide synthesized by mitochondria. The migration of this protein on polyacrylamide gels corresponds to the highest-molecular-weight subunit of cytochrome oxidase.