Eiki Tsushima

An ankle-foot orthosis with inhibitor bar: effect on hemiplegic gait.

OBJECTIVE To test whether an inhibitor bar attached to an ankle-foot orthosis (AFO) improves walking ability in hemiplegic stroke patients with tonic toe flexion reflex (TTFR). DESIGN Before-after trial. SETTING Rehabilitation hospital in Japan. PARTICIPANTS Nine patients with TTFR were assigned to the TTFR group, and 8 patients without TTFR were assigned to the control group. INTERVENTION Inhibitor bar attached to an AFO. MAIN OUTCOME MEASURE Gait was analyzed by measuring the number of steps and the time required to walk 10m at a maximal walking speed. RESULTS In the TTFR group, use of an inhibitor bar for 2 weeks significantly increased the maximal walking speed, stride length, and cadence by 13.8% (P=.0045), 8.0% (P=.0398), and 6.1% (P=.0056), respectively. There were no significant changes in the control group. CONCLUSION An inhibitor bar improved walking ability of hemiplegic patients with TTFR, and its use with an AFO is recommended.

Validation of Risk Scoring System Excluding Female Sex From CHA2DS2-VASc in Japanese Patients With Nonvalvular Atrial Fibrillation – Subanalysis of the J-RHYTHM Registry –

BACKGROUND Because the current Japanese guideline recommends CHADS2 score-based risk stratification in nonvalvular atrial fibrillation (NVAF) patients and does not list female sex as a risk for thromboembolic events, we designed the present study to compare the CHA2DS2-VASc and CHA2DS2-VA scores in the J-RHYTHM Registry. METHODS AND RESULTS We prospectively assessed the incidence of thromboembolic events for 2 years in 997 NVAF patients without warfarin treatment (age 68±12 years, 294 females). The predictive value of the CHA2DS2-VASc and CHA2DS2-VA scores for thromboembolic events was evaluated by c-statistic difference and net reclassification improvement (NRI). Thromboembolic events occurred in 7/294 females (1.2%/year) and 23/703 males (1.6%/year) (odds ratio 0.72 for female to male, 95% confidence interval (CI) 0.28-1.62, P=0.44). No sex difference was found in patient groups stratified by CHA2DS2-VASc and CHA2DS2-VA scores. There were significant c-statistic difference (0.029, Z=2.3, P=0.02) and NRI (0.11, 95% CI 0.01-0.20, P=0.02), with the CHA2DS2-VA score being superior to the CHA2DS2-VASc score. In patients with CHA2DS2-VASc scores 0 and 1 (n=374), there were markedly significant c-statistic difference (0.053, Z=6.6, P<0.0001) and NRI (0.11, 95% CI 0.07-0.14, P<0.0001), again supporting superiority of CHA2DS2-VA to CHA2DS2-VASc score. CONCLUSIONS In Japanese NVAF patients, the CHA2DS2-VA score, a risk scoring system excluding female sex from CHA2DS2-VASc, may be more useful in risk stratification for thromboembolic events than CHA2DS2-VASc score, especially in identifying truly low-risk patients.

Clinical outcome of stereotactic body radiotherapy for primary and oligometastatic lung tumors: a single institutional study with almost uniform dose with different five treatment schedules

BackgroundTo evaluate clinical outcomes of stereotactic body radiotherapy (SBRT) for localized primary and oligometastatic lung tumors by assessing efficacy and safety of 5 regimens of varying fraction size and number.MethodsOne-hundred patients with primary lung cancer (n = 69) or oligometastatic lung tumors (n = 31), who underwent SBRT between May 2003 and August 2010, were included. The median age was 75 years (range, 45–88). Of them, 98 were judged to have medically inoperable disease, predominantly due to chronic illness or advanced age. SBRT was performed using 3 coplanar and 3 non-coplanar fixed beams with a standard linear accelerator. Fraction sizes were escalated by 1 Gy, and number of fractions given was decreased by 1 for every 20 included patients. Total target doses were between 50 and 56 Gy, administered as 5–9 fractions. The prescribed dose was defined at the isocenter, and median overall treatment duration was 10 days (range, 5–22).ResultsThe median follow-up was 51.1 months for survivors. The 3-year local recurrence rates for primary lung cancer and oligometastasis was 6 % and 3 %, respectively. The 3-year local recurrence rates for tumor sizes ≤3 cm and >3 cm were 3 % and 14 %, respectively (p = 0.124). Additionally, other factors (fraction size, total target dose, and BED10) were not significant predictors of local control. Radiation pneumonia (≥ grade 2) was observed in 2 patients. Radiation-induced rib fractures were observed in 22 patients. Other late adverse events of greater than grade 2 were not observed.ConclusionWithin this dataset, we did not observe a dose response in BED10 values between 86.4 and 102.6 Gy. SBRT with doses between 50 and 56 Gy, administered over 5–9 fractions achieved acceptable tumor control without severe complications.

Interobserver and intraobserver reliability of the classification and diagnosis for ossification of the posterior longitudinal ligament of the cervical spine

PurposeOssification of the posterior longitudinal ligament (OPLL) of the cervical spine has been classified into four types by lateral plain radiographs, but the reliability of the classification and of the diagnosis of either cervical OPLL or cervical spondylotic myelopathy (CSM) was unknown. We investigated the interobserver and intraobserver reliability of the classification and diagnosis for OPLL by radiographs and computed tomography (CT) images.MethodsA total of 16 observers classified each patient’s images into five groups; OPLL continuous, segmental, mixed, circumscribed type, or CSM. To evaluate interobserver reliability, the observers first classified only radiograph images, and next both radiographs and CT images. On another day they followed the same procedure to evaluate intraobserver reliability. We also evaluated interobserver and intraobserver reliability of the diagnosis of either cervical OPLL or CSM.ResultsInterobserver reliability of the classification with radiographs only showed moderate agreement, but interobserver reliability with both radiographs and CT images showed substantial agreement. Intraobserver of reliability the classification was also improved by additional CT images. Interobserver reliability of the diagnosis with both radiographs and CT images was almost similar to with radiographs only. Intraobserver reliability of the diagnosis was improved by additional CT images.ConclusionsThis study suggested that the reliability of the classification and diagnosis for cervical OPLL was improved by additional CT images. We propose that diagnostic criteria for OPLL include both radiographs and CT images.

Comparison of impact force attenuation by various combinations of hip protector and flooring material using a simplified fall-impact simulation device

Use of hip protectors and compliant flooring has been recommended for preventing hip fracture due to falls. We aimed to identify the factors attenuating forces in falls by comparing and analyzing the impact forces occurring with various combinations of hip protectors and flooring materials. We designed a simplified pendulum device to simulate the impact force at the hip during falling. The impact force was measured on pressure-sensitive recording film under combined conditions of two kinds of hip protector (hard or soft shell) and three kinds of floor material (concrete, wooden, or tatami matting). We then calculated the percentage force attenuation under each test condition compared with the use of a concrete floor and no hip protector. All the tests using tatami matting reduced the impact to below the average fracture threshold of elderly people (3472N). A combination of tatami and soft hip protector provided the best attenuation (72.5%). Multiple regression analyses showed that use of tatami matting and a soft hip protector had the biggest force-attenuation effect. The soft hip protector gave better percentage force attenuation than did the hard one. Use of tatami matting as a flooring material could be an effective strategy for helping prevent hip fractures.

A novel parameter, cell-cycle progression index, for radiation dose absorbed estimation in the premature chromosome condensation assay.

The calyculin A-induced premature chromosome condensation (PCC) assay is a simple and useful method for assessing the cell-cycle distribution in cells, since calyculin A induces chromosome condensation in various phases of the cell cycle. In this study, a novel parameter, the cell-cycle progression index (CPI), in the PCC assay was validated as a novel biomarker for biodosimetry. Peripheral blood was drawn from healthy donors after informed consent was obtained. CPI was investigated using a human peripheral blood lymphocyte (PBL) ex vivo irradiation ((60)Co-gamma rays: ∼0.6 Gy min(-1), or X ray: 1.0 Gy min(-1); 0-10 Gy) model. The calyculin A-induced PCC assay was performed for chromosome preparation. PCC cells were divided into the following five categories according to cell-cycle stage: non-PCC, G1-PCC, S-PCC, G2/M-PCC and M/A-PCC cells. CPI was calculated as the ratio of G2/M-PCC cells to G1-PCC cells. The PCC-stage distribution varied markedly with irradiation doses. The G1-PCC cell fraction was significantly reduced, and the G2/M-PCC cell fraction increased, in 10-Gy-irradiated PBL after 48 h of culture. CPI levels were fitted to an exponential dose-response curve with gamma-ray irradiation [y = 0.6729 + 0.3934 exp(0.5685D), r = 1.0000, p < 0.0001] and X-ray irradiation [y = -0.3743 + 0.9744 exp(0.3321D), r = 0.9999, p < 0.0001]. There were no significant individual (p = 0.853) or gender effects (p = 0.951) on the CPI in the human peripheral blood ex vivo irradiation model. Furthermore, CPI measurements are rapid (< 15 min per case). These results suggest that the CPI is a useful screening tool for the assessment of radiation doses received ranging from 0 to 10 Gy in radiation exposure early after a radiation event, especially after a mass-casualty radiological incident.

Comparison of activity level in daily life with heart rate: Application to elderly persons of different ambulatory abilities.

ObjectivesNormal activity monitoring methods are mainly useful for relatively healthy and ablebodied people, but are not necessarily appropriate for elderly persons who may have difficulty in walking, or for the frail who may be bedridden. The purpose of this study was to examine 24-hour heart rate recording for the comparison of activity levels in daily life of elderly persons of different ambulatory abilities.MethodsForty-two elderly females (mean, 82.1 years old) volunteered to participate in this study. The subjects were divided into four groups on the basis of their ambulatory status, and their 24-hour heart rate recordings were compared with their results of activity assessments.ResultsThe results of activity assessments showed a tendency to decrease as the ambulatory ability of the group decreased. The “total heart beats”, calculated as the sum of all heart rates over 24 hours, were almost the same among the four groups, and therefore did not show a similar tendency. However, the “total excess-beats product (TEBP)” correlated with the results of activity assessments. TEBP was calculated as the sum of all differences in beats between each heart rate in 24 hours and the mean heart rate during sleeping at night. Therefore, TEBP may reflect a more active state than the bedridden state.ConclusionsThese results suggest that comparison of activity levels in daily life using 24-hour heart rate recording might be possible by the calculation of TEBP, and that this method might be useful for the comparison of the activity levels of elderly persons of diffent ambulatory abilities.

Whole-Body Counter(WBC) and food radiocesium contamination surveys in Namie, Fukushima Prefecture

Purpose This study examined the internal Cs exposure of residents and the Cs present in food products produced in Namie. Whole-body counter (WBC) was used for the measurement of internal exposure per each whole body of examinees. Methods The food products which appeared to be used for consumption, were brought by residents and commercially available food items were excluded. Most of them were wild plants or food items produced by residents. Four years of data from April 2012 to March 2013 (fiscal 2012) and April 2015 to March 2016 (Fiscal 2015) were analyzed and studied. Results The average radioactivity measured by WBC was approximately 5 Bq for Cs-134, and 20 Bq for Cs-137 and the average committed effective dose was approximately 1 μSv. The average for the residents with detectable radioactivity was 25 μSv, and the human health effects are considered to be extremely low risk. However, the radioactivity of the affected individuals showed a higher value than the theoretical attenuation rate. The majority (83.2%) of individuals exhibiting radioactivity were over 50 years old. The number of food products brought in for detection decreased as the study period progressed, but the number of food products with radioactivity had increased. While the items with a higher detection rate of radioactivity included fruits such as citron and persimmon, shiitake mushrooms exhibited the highest radioactivity. Moreover, the radioactivity of seven items in these 10 items decreased from fiscal 2012 to fiscal 2015. Mushrooms had high radioactivity and were produced over a wide area. Conclusion We suggest that the elderly try to enjoy life and eat wild plants in moderation while inspecting food products. Therefore, we will continue to work in raising awareness of radiation and its potential presence in food products and thus the continuing necessity of monitoring radioactivity in food in the future.

The Reliabilities of Several Measurement Methods of Cervical Sagittal Alignment in Cases with Cervical Spine Rotation Using X-ray Findings in Cervical Spine Disorders

Introduction Several measurement methods designed to provide an understanding of cervical sagittal alignment have been reported, but few studies have compared the reliabilities of these measurement methods. The purpose of the present study was to investigate the intraexaminer and interexaminer reliabilities of several cervical sagittal alignment measurement methods and of the rotated cervical spine using plain lateral cervical spine X-rays of patients with cervical spine disorders. Methods Five different measurement methods (Bordens method; Ishihara index method (Ishihara method); C2-7 Cobb method (C2-7 Cobb); posterior tangent method: absolute rotation angle C2-7 (ARA); and classification of cervical spine alignment (CCSA)) were applied by seven examiners to plain lateral cervical spine X-rays of 20 patients (10 randomly extracted cases from a rotated cervical spine group and 10 from a nonrotated group) with cervical spine disorders. Case 1 and Case 2 intraclass correlation coefficients (ICCs) were used to analyze intraexaminer and interexaminer reliabilities. The necessary number of measurements and the necessary number of examiners were also determined. The target coefficient of correlation was set at ≥0.81 (almost perfect ICC). Results In both groups, an ICC(1, 1) ≥ 0.81 was obtained with Bordens method, the Ishihara method, C2-7 Cobb, and ARA by all examiners. The necessary number of measurements was 1. With CCSA, a kappa coefficient of at least 0.9 was obtained. In both groups, with Bordens method, the Ishihara method, C2-7 Cobb, and ARA, the ICC(2, 1) was ≥0.9, indicating that the necessary number of examiners was 1. The standard error of measurement (SEM) was lowest with Bordens method, and the Ishihara method and C2-7 Cobb had almost the same values. Conclusions Among cervical sagittal alignment measurement methods for cervical spine disorders, regardless of cervical spine rotation, Bordens method, Ishihara method, and C2-7 Cobb offer stronger reliability in terms of the ICC and SEM.

Effects and Risks of Heparin Bridging and Different Modes of Interruption/Resumption of Rivaroxaban on Perioperative Complications of Catheter Ablation for Atrial Fibrillation ― Another Analysis of the JACRE-R Registry ―

BACKGROUND The JACRE-R Registry, in which 42 Japanese institutions participated, monitored the efficacy and safety of rivaroxaban in catheter ablation (CA) of atrial fibrillation (AF). In the present analysis, we sought to elucidate the effects and risks of heparin bridging and different patterns of interruption/resumption of rivaroxaban on complications of CA.Methods and Results:We administered rivaroxaban during the perioperative period and recorded the incidence of complications up to 30 days after CA. A total of 1,118 patients were registered; 546 received heparin bridging and 572 did not. The bridging group showed a significantly higher incidence of non-major bleeding than the no-bridging group (4.03% vs. 0.87%; P=0.001). In the group receiving their last dose of rivaroxaban at 8-28 h before CA, neither thromboembolism nor major bleeding was observed during or after CA and the incidence of non-major bleeding was low (4/435, 0.92%). The incidence of non-major bleeding was significantly higher in the group resuming rivaroxaban ≥12 h after CA than in the group resuming <12 h (1.79% vs. 0.27%, P=0.045). CONCLUSIONS Heparin bridging increased the risk of non-major bleeding perioperatively. It was safe to stop rivaroxaban 8-28 h before the CA procedure, whereas resumption of the drug within 12 h of CA was associated with a lower incidence of non-major bleeding.