Shin-ichiro Takasugi

Short-term intensive treatment for donors with hepatic steatosis in living-donor liver transplantation.

Background. The use of steatotic livers is associated with increased primary nonfunction in liver transplantation. To reduce the risk of liver injury, we applied a short-term combination therapy of diet, exercise and drugs for 11 living-donor liver transplantation (LDLT) candidates with steatosis. Methods. Subjects were treated with a protein-rich (1000 kcal/day) diet, exercise (600 kcal/day), and bezafibrate (400 mg/day) for 2–8 weeks. Results. The treatment significantly improved macrovesicular steatosis (30±4% vs. 12±2% [mean±SEM], P= 0.0028). Body weight and BMI were significantly reduced (73.7±3.2 kg vs. 66.9±2.9 kg, P=0.0033, 26.4±0.7 kg/m2 vs. 24.1±0.8 kg/m2, P=0.0033). The treatment completely normalized liver function tests and lipid metabolism. Seven treated liver grafts (left lobe) were transplanted to the recipients. We compared transplanted graft function and resected liver function of donors using parameters such as peak total bilirubin, prothrombin time at postoperative day 3, and peak alanine aminotransferase between treated liver (n=7) and donor liver without hepatic steotosis (n=37). The transplanted grafts showed good liver functions, and there was no difference between them with respect to functional parameters. The treated donors also showed good liver functions, and no significant differences in functional parameters. Conclusions. The results of this study indicate that our short-term treatment effectively reduced steatosis and contributed to safer LDLT. Our findings also suggest that even severely steatotic livers can be used for LDLT grafting subsequent to our short-term treatment regimen.

Muscle activity and heart rate response during backward walking in water and on dry land

AbstractThe primary purpose of this study was to examine whether walking backward in water and walking backward on dry land elicit different electromyographic (EMG) activities in lower-extremity and trunk muscles. Surface EMG was used to evaluate muscle activities while six healthy subjects walked backward in water (with and without a water current, Water + Cur and Water − Cur, respectively) immersed to the level of the xiphoid process, and while they walked backward on dry land (DL). The trials in water utilized the Flowmill which consists of a treadmill at the base of a water flume. Integrated EMG analysis allowed the quantification of muscle activities. The measurement of maximal voluntary contraction (MVC) of each muscle was made prior to the gait analysis, and all data were expressed as the mean (SD). The %MVCs from the muscles tested while walking backward in water (both with and without a current) were all significantly lower than those obtained while walking backward on dry land ( P<0.05), with the exception of the paraspinal muscles. In the case of the paraspinal muscles, the %MVC while walking backward with a water current was significantly greater than when walking backward on dry land [Water + Cur 19.4 (6.8)%MVC vs. DL 13.1 (1.4)%MVC; P<0.05], or walking backward without a water current [vs. Water − Cur 13.3 (1.8)%MVC; P<0.05]. Furthermore, when walking backward in water, the %MVCs from the muscles investigated were significantly greater in the presence of a water current than without ( P<0.05). In conclusion, walking backward in water with a current elicits the greatest muscle activation of the paraspinal muscles. These data may help in the development of water-based exercise programs.

Positive relationship between bone mineral density and low back pain in middle-aged women

There have been a large number of epidemiological studies demonstrating various primary factors that cause musculoskeletal disorders in middle-aged and older women. However, the relationship between low back pain and bone mineral density is not well documented, and no evidence for any direct relationship between the two has been found. To investigate the relationship, we conducted a cross-sectional study, on a population of 2,244 Japanese women aged 25–85 years who were participating in a regional health screening program. Information on lifestyle, reproductive characteristics and the presence of current low back pain was collected by self-administered questionnaires, and bone mineral density at the distal radius was measured. We found increasing bone mineral density to be significantly associated with low back pain in middle-aged women using a logistic regression analysis. Exercise and smoking were also significantly associated with low back pain. This association remained even after entering other lifestyle and reproductive factors into the final model. Accordingly, high bone mineral density would seem to be as important a public health problem as low bone mineral density and osteoporosis when considering the musculoskeletal symptoms and disabilities that appear in middle-aged women.

GTP-dependent and -independent activation of superoxide producing NADPH oxidase in a neutrophil cell-free system

GTP and GTP‐γ‐S enhanced several‐fold the NADPH‐dependent superoxide production induced by sodium dodecyl sulfate in a cell‐free system of pig neutrophils consisting of the membrane fraction and two cytosolic fractions separated by gel filtration. The enhanced activity was decreased by the addition of GDP in a dose‐dependent manner, but 70% of the activity in the absence of GTP remained even at 1 mM GDP. Only one cytosol fraction besides the membrane fraction was required for the activation in the presence of GTP. The cytosol fraction was analyzed by chromatography on 2′,5′‐ADP agarose and two components responsible for the GTP‐dependent and independent activation were separated. These results suggest that at least two pathways are available for the activation of superoxide production in the cell‐free system of pig neutrophils.

Varus–valgus laxity correlates with pain in osteoarthritis of the knee

Pain during osteoarthritis (OA) of the knee does not necessarily correlate with the severity of the radiographic grade, and the mechanism of pain has not been completely clarified. The purpose of this study was to evaluate risk factors for pain in the knee OA using epidemiologic analyses. We evaluated 518 out of 4183 people over the age of 40 (156 males and 362 females) from Shinyoshitomi village, Japan. Mean ages were 63.8 years for men and 60.7 years for women. Screening included a physical examination of the knee and a standing AP roentgenogram of the bilateral knee. Radiographic OA was defined as a Kellgren-Lawrence grade 2 or higher. All data were coded and pain risk factors were evaluated using a multiple logistic regression model. Radiographic OA was observed in 18.4% of men and 26% of women. Of these subjects with OA, 10.9% of men and 32.5% of women complained of knee pain. Seven factors-age, gender, BMI, radiographic grade, varus-valgus laxity, torque of quadriceps muscles, and varus-valgus alignment-were evaluated as potential risk factors for pain. A significant increase in the odds ratio was observed with varus-valgus laxity (p=0.005; odds ratio, 3.04). Our results suggest that varus-valgus laxity is a risk factor for pain during knee OA.

Gait Phase Detection Using Foot Acceleration for Estimating Ground Reaction Force in Long Distance Gait Rehabilitation

In gait rehabilitation, achieving a gait analysis method using a simple system during long-distance walking is important. This method is required to measure all gait parameters in a single measurement. In addition, it is required that the measurement system is not spatially constrained. Therefore, we have been developing a gait tracking system with acceleration sensors for long-distance gait rehabilitation. In this paper, we describe a gait phase detection method using foot acceleration data for estimating ground reaction force during long-distance gait rehabilitation. To develop this method, we focused on the jerk of each foot in vertical axis direction. Using two accelerometers mounted on the left and right feet, we carried out three experiments. First, we measured the jerk of each foot during a free gait to verify the relation with the walking speed. Second, we measured the jerk of each foot during walking faster than normal for each subject. We then compared these results with the results of first experiments. Finally, we measured the jerk of each foot during left-right asymmetrical walking. The results confirmed that gait phase could be detected using the jerk of each leg, calculated from acceleration data in vertical axis direction. In particular, the timing of Heel-contact / Toe-off could be obtained with an average error of 0.03 s. And as a preliminary study, we estimated the ground reaction force using the one of the results.

Two subtypes of radiographic osteoarthritis in the distal interphalangeal joint of the hand.

BackgroundThe etiology and pathogenesis of hand osteoarthritis (OA) are not completely clarified, and several factors may cooperate in a multifactorial fashion in its development. The purpose of this study was to clarify the effects of the dominant hand that contribute to the development of distal interphalangeal (DIP) joint OA using epidemiological analyses.MethodsA total of 518 subjects (156 men, 362 women) in a rural community were analyzed. Their mean age was 63.8 years for men and 60.7 years for women. Anteroposterior (AP) standing radiographs of bilateral knees, lateral views of the lumbar spine, and AP views of bilateral hands were obtained. Furthermore, a survey of their life patterns was conducted using self-administered questionnaires. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade 2 or higher. Hand OA was limited to Heberden’s nodes. Generalized OA (GOA) was defined as bilateral knee OA plus lumbar spine OA.ResultsGOA was observed in 13.0% of the subjects. The incidence of DIP joint OA was significantly higher in the GOA group than that in the non-GOA group. In the GOA group, the incidence of right-hand DIP joint OA in right-handed and left-handed subjects was 37.5% and 40.0%, respectively, without a significant difference. In the non-GOA group, however, the incidence of right-hand DIP joint OA in right-handed and left-handed subjects was 16.4% and 3.2%, respectively, with a significant difference. With a multiple logistic regression model, the P value of the handedness was marginal (0.060), but a clear tendency of increase in the odds ratio (7.129) was observed in the dominant hand for the non- GOA group. In contrast, there was no effect of the handedness on right-hand DIP joint OA in the GOA group.ConclusionsThere are two subtypes of hand DIP joint OA in terms of the etiology. One is environmental, and the other is genetic.

Osteoporosis and years since menopause

In Fukuoka Prefecture, in south-western Japan, a regional screening program for osteoporosis was conducted from 1994 to 1995. The screening level in the bone mineral density (BMD) at the distal non-dominant radius was equal to or less than two standard deviations below age-specific mean (≤ −2.0 SD). In 1177 examinees with natural menopause (mean age: 61.4, range: 42–88), 56 of those who were screened were subsequently radiologically confirmed by orthopedic specialists to have osteoporosis (case group). They were then compared with 802 normal BMD (≥ −1.0 SD) women (reference group) with their lifestyle and reproductive characteristics. The adjusted odds ratio (OR) and its 95% confidence interval (CI) were calculated using a logistic regression model. A significant increase in the ORs for osteoporosis based on the number of years since menopause was observed for 7–13 years since menopause (OR=2.3; 95% CI: 1.0–5.4) compared with <7 years, however, no increasing trend in risk was evident in 14+ years since menopause (OR=1.4; 95% CI: 0.4–5.1). Thus, the elevated risk continued up to around 10 years since menopause. These findings are consistent with previous studies that reported an alternation in the calcium metabolism and bone loss related to the length of time after menopause. Both the childhood and current milk consumption were also associated with a decreased risk: ORs were 0.4 (95% CI: 0.2–0.9) and 0.5 (95% CI: 0.3–1.0), respectively.

Characteristic analysis of an air cell for active air mattress of prevention for pressure ulcer

Today, the number of elderly people in Japan is increasing, and the number of families who have members in need of nursing care is also increasing. A home care is promoted by Japanese government, but there is a big problem of a pressure ulcer. Accordingly, many types of antidecubitus aids have been developed. However, these aids are not enough for controlling the body pressure. To address this problem, we developed novel active air mattress, which has soft pressure sensor sheet and can control its air cells independently. In this paper, we analyze the characteristics of the air cell and the relationship between value of the sensors and states of the mattress. As a result, we demonstrate that the condition of the mattress can be estimated from sensor values. Graphical Abstract