Effectiveness of a Conditioning Program on Amateur Female Marathon Runners.

There is a sudden rise in the participation of middle-aged women in marathons across India without proper knowledge about how to prepare for these marathons. This leads to rise in injuries in them like low back pain, knee pain, stress fractures, urinary incontinence etc., some of which can easily be avoided. There is a need to find out a suitable conditioning program for these participants that will target problems affecting this age group and gender specifically. The objective of this study was to determine the effect of conditioning program on post run physical functioning in female amateur marathon runners. Pain Assessment, DOMS, Modified Borg Scale were used for assessing the individuals. METHODSIn this comparative study, 52 amateur female marathon runners, were randomly allocated into two groups with 26 runners in each group. We evaluated pain and exertion using pain assessment and Borg Scale. Occurrence of incontinence was assessed by asking a simple ‘yes’ or ‘no’ question. Delayed onset muscle soreness (DOMS) was assessed using pain pressure threshold (PPT) 24 hrs. post run. RESULTSThere was a significant effect of the conditioning program on these female runners compared to administration of no conditioning at all. There was a reduction of pain in all the components of the pain scale (p= <0.001). Exertion of the trained runners was also less (p= <0.001) as well as in the occurrence of incontinence (p= <0.0430). PPT was also substantially increased in them (p= <0.001). CONCLUSIONSThe conditioning program administered to amateur female marathon runners was effective in reducing their risk of injuries and problems related to women’s health that occur while running a marathon.

Clinical presentations and comparative outcomes of primary versus deferred intraocular lens explantation in delayed-onset endophthalmitis

Purpose: To describe clinical presentations and comparative outcomes of primary versus deferred intraocular lens (IOL) explantation in delayed-onset endophthalmitis. Methods: In this retrospective study, a total of 77 eyes of 77 patients that were diagnosed clinically as delayed-onset endophthalmitis and underwent IOL explantation from January 1990 to January 2018 were included undiluted vitreous biopsy and IOL were subjected to microbiologic evaluation. Duration of symptoms, presenting visual acuity, organisms isolated, time to IOL explantation, time to endophthalmitis, resolution after explantation, number of repeat intravitreal injections, and final visual acuity were compared in the primary and the deferred IOL explantation groups. Results: There were primary and deferred IOL explantations. Interval between inciting event and endophthalmitis, between onset of symptoms to presentation, total follow-up, complication rate, and final visual acuity was comparable between the two groups. Median time to IOL explantation in the deferred group was 70 days. Between the primary and deferred IOL explantation groups the number of repeat intravitreal injections was 0.58 ± 0.86 and 2.62 ± 1.78 respectively, (P < 0.0001, 95% confidence interval, CI 2.00–2.22); the number of days to resolution after IOL explantation was 35.16 ± 14.26 and 55.5 ± 8.24 respectively, (P < 0.0001, 95% CI 15.22–25.45). Conclusion: Early IOL explantation in delayed-onset endophthalmitis causes faster clinical resolution and reduces the number of repeat intravitreal injections. Final visual improvement, however, may be unaffected.

Micetismos: Parte 2: Síndromes con sintomatología demorada y latencia muy larga / Mushroom poisonings. Part 2: Delayed-onset syndromes with very long latency time

En este trabajo se analizan los micetismos menos comunes, caracterizados por la aparición demorada de síntomas y por tiempos de latencia muy largos. Estas intoxicaciones son provocadas por especies de hongos ectomicorrícicos poco comunes. Se analizan: a) Toxíndrome nefrotóxico demorado o retrasado. Micetismo orellánico o por orellanina. b) Toxíndrome con rabdomiólisis. Micetismos por Tricholoma equestre y Tricholoma terreum. c) Toxíndrome encefalopático o neurotóxico retrasado. Micetismo por Pleurocybella porrigens. d) Toxíndrome cardiovascular. Micetismo por Trogia venenata. Se discuten el tiempo de incubación, las características sintomatológicas, el curso clínico, las toxinas responsables de cada micetismo y su mecanismo de acción, y el tratamiento que ha resultado efectivo para la recuperación de los pacientes.

Less common mycetisms, characterized by delayed-onset and very long latency times are analyzed. These intoxications are caused by rare ectomycorrhizal fungal species. The following syndromes have been taken into account: (a) Delayed nephrotoxic syndrome. Orellanic mycetism or mycetism due to orellanin. (b) Syndrome with rhabdomyolysis. Mycetisms by Tricholoma equestre, and Tricholoma terreum. (c) Delayed encephalopathic or neurotoxic syndrome. Mycetism by Pleurocybella porrigens. (d) Cardiovascular syndrome. Mycetism by Trogia venenata. The incubation time, symptom characteristics, clinical course, toxins responsible for each mycetism and their mechanism of action, and treatment that has shown to be effective for patient recovery are discussed.

Neste trabalho, analisam-se micetismos menos comuns, caracterizados pelo aparecimento retardado de sintomas e tempos de latência muito longos. Essas intoxicações são causadas por espécies raras de fungos ectomicorrízicos. São analisados os seguintes: (a) síndrome de toxicidade nefrotóxica retardada ou atrasada. Micetismo orelânico ou micetismo por orelanina. (b) Toxíndrome com rabdomiólise. Micetismo por Tricholoma equestre e Tricholoma terreum. (c) Toxicidade tardia encefalopática ou neurotóxica. Micetismo por Pleurocybella porrigens. (d) Síndrome cardiovascular. Miceticismo por Trogia venenata. O tempo de incubação, as características sintomatológicas, o curso clínico, as toxinas responsáveis por cada micetismo e seu mecanismo de ação e o tratamento efetivo para a recuperação dos pacientes são discutidos.

Activation of Multifidus and Erector Spinae Muscles during Upper Limb Flexion and Abduction in Patients with Nonspecific Low Back Pain / 中国康复理论与实践

Objective:To compare the difference in the onset time of the trunk muscles activity in individuals with and without nonspecific low back pain (NLBP) during upper limb flexion and abduction. Methods:From September to December, 2017, 21 patients with NLBP (NLBP group) and 21 volunteers (control group) participated in this study. Surface electromyography (sEMG) signals were recorded from the anterior deltoid, middle deltoid, multifidus and erector spinae muscles during upper limb flexion and abduction in standing position. Relative differences in the onset times between each muscle and the prime mover were calculated. Results:During upper limb flexion, the right multifidus muscle, bilateral erector spinae were activated in advance of the agonist muscle (anterior deltoid), while the left multifidus muscle was delayed relative to the agonist muscle in both groups. The onset time of the right erector spinae was significantly delayed in NLBP group than in the control group (t = -2.393, P = 0.019). During upper limb abduction, bilateral multifidus muscle and bilateral erector spinae were activated in advance of the agonist muscle (middle deltoid) in the control group. Additionally, in NLBP group, the left erector spinae was activated in advance of the agonist muscle, bilateral multifidus and right erector spinae were delayed relative to the agonist muscle. There was no significant difference in the relative onset time between both groups (t < 1.393, P > 0.05). Conclusion:During upper limb flexion and abduction, the trunk muscles of the lower back are activated in advance for healthy individuals, while individuals with NLBP have a possibly delayed activation of trunk muscles.

The Effect of Kinesio Taping Pre-intervention on Delayed Onset Muscle Soreness

PURPOSE: This examined the effect of Kinesio taping pre-intervention on the pain, tenderness, proprioceptive sensation, and muscle strength associated with delayed onset muscle soreness. METHODS: Thirty subjects were divided into a Kinesio taping application group of 15 subjects and a control non-taped group of 15 subjects, and the changes in individual variables were analyzed before taping and at 24, 48, and 72 hours after taping using two-way repeated ANOVA. Post-hoc t-tests were conducted in the cases with intergroup interactions, and the significance level α was set to α=0.01. RESULTS: The changes in pain during rest were significantly different only for the times, while the changes in pain during exercise were significantly different for the times, interactions between the times and groups, and intergroup changes (p<0.05). The changes in tenderness were significantly different for the times and for interactions between the times and groups (p<0.05). The changes in proprioceptive sensation were significantly different for the times, interactions between times and groups, and intergroup changes (p<0.05). The changes in muscle strength were significantly different only for the times (p<0.05). CONCLUSION: The application of Kinesio taping had positive effects on the pain, tenderness, and proprioceptive sensation of delayed onset muscle soreness. These results suggest that Kinesio taping can be a useful therapeutic factor in future studies and in clinical settings.

Delayed-Onset Heparin-Induced Thrombocytopenia Following Aortic Valve Replacement / 日本心臓血管外科学会雑誌

Some 50% of patients who undergo cardiac surgery will have heparin-induced thrombocytopenia (HIT) antibodies, only 1% will develop typical clinical HIT. Especially delayed-onset HIT is not well-known and extremely rare. A 83-year-old man underwent aortic valve replacement (AVR) with a bioprosthetic valve (Mitroflow 21 mm) and pulmonary vein isolation (PVI). Intravenous unfractionated heparin (8,000 I.U./day) was administered for 5 days after surgery. He had a good recovery and was discharged to home with a platelet count of 100,600/μl on POD 15 on warfarin. On POD 18, he was readmitted to our hospital due to cerebral infarction with hemiparesis. As MRI revealed a multiple left hemispheric infarction, the presence of cardiogenic cerebral infarction was suspected. Continuous intravenous administration of unfractionated heparin (15,000 I.U./day) was started. On POD 24, the platelet count fell to 27,000/μl, and a contrast CT scan revealed a giant thrombus in the aortic arch. He was found to have HIT antibodies, supporting a diagnosis of HIT. After cessation of heparin therapy and administration of vitamin K antagonist, argatroban was administered. He recovered neurologically and was discharged on POD 58. He remains well at 3 years follow up. If a patient has an unexplained and severe thrombocytopenia after cardiovascular surgery, delayed-onset HIT should be taken into consideration.

Effects of MG53 knock-out on skeletal muscle damage of mice during delayed onset muscle damage / 中国康复医学杂志

Objective:To discuss the effect of knock-out MG53 on skeletal muscle,and to determine whether MG53 can protect skeletal muscle from injury during delayed onset muscle damage(DOMS).Method:Eighty-four eight-week old C57 mice were divided into two groups due to their gene (WT and KO),and each group were divided into 7 subgroups again.14 groups,6 mice in each.They were WC,WE0,WE2,WE12,WE24,WE48,WE72 and KC,KE0,KE2,KE12,KE24,KE48,KE72.At each time point after 3 days eccentric exercise,the mice were decapitated after drawing blood.The rectus femoris of left leg was used to detect the level of MG53 with Western blot,the other side were used to do electron microscope analysis.Blood CK were measured also.Result:The CK of K0 raised remarkably and decreased gradually until W 12.But the second peak appear at W24 and decreased again gradually since then.Ultrastructural changes of skeletal muscle after eccentric exercise at different time points is obvious.The injury is worsen gradually from Wo to W24,and improved gradually from W48 to W72.Comparing with W groups,the injury in K group were even worsen an each time point.The MG53 of W0 and W24 were 16％ and 11％ higher than those before exercise (p＜0.05)and restored to normal in 72 hours after exercise.Conclusion:The injury after severe exercise is more severity in MG53 knock-out mouse than those in wild mouse.and the MG53 protein increased significantly.It suggests that MG53 may significantly relieve the skeleton muscle injury in delayed muscle sore period.

Research progress on irinotecan induced metabolic dysregulation in microbiota- gut-liver axis and Chinese materia medica intervention / 中草药

Irinotecan was a commonly used chemotherapeutic drug for treating colorectal cancer recurrence and deterioration. Despite its good efficacy, gastrointestinal toxicities such as delayed-onset diarrhea, nausea, and vomiting have severely restrained its clinical application. Recent studies have suggested that the gastrointestinal toxicities of irinotecan were closely related to its metabolism in microbiota-gut-liver axis and the associated bile acid and tryptophan metabolic disturbance. Therefore, this review was mainly focused on the relationship between the disturbed metabolism of endogenous and gastrointestinal toxicities of irinotecan. What’s more, in order to provide reference for further study and development of related drugs, the effect of Chinese materia medica in intervention and treatment of irinotecan-induced gastrointestinal toxicity have also been discussed.

Correlation between gestational diabetes mellitus and delayed onset of lactogenesis / 中华护理杂志

Objective To explore the correlation between gestational diabetes mellitus(GDM) and delayed onset of lactogenesis(DOL),providing references for prevention of DOL among gravidas with GDM.Methods From March to September 2016,gravidas in three tertiary hospitals in Nanjing for antenatal examination were screened for glucose tolerance,and 275 gravidas diagnosed with GDM were assigned into the GDM group,275 gravidas with normal glucose tolerance were assigned into the non-GDM group.Timing of maternal perception of onset of lactogenesis (OL) was recorded and breast milk postpartum 48h to 72h was collected for detecting lactose concentration.Chisquare test was used to compare rate of DOL in two groups,t-test was used to compare difference of lactose concentration between two groups,Pearson correlation was used to analyze the relationship of lactose concentration in breast milk and timing of OL,and multiple logistic regression model was used to analyze impact of GDM on DOL.Results Rate of DOL in the GDM group was higher than that in the non-GDM group,and the difference was statistically significant(P＜0.05).Lactose concentration in the GDM group was lower than that in the non-GDM group,and the difference was statistically significant(P＜0.05).There was a negative linear correlation between lactose concentration and timing of OL 48-72h after delivery.Primipara and GDM were risk factors of DOL.Conclusion Timing of OL among GDM puerperae is later than non-GDM puerperae,and GDM puerperae are at higher risk of DOL.More attention should be paid and measures should be taken for its prevention.

Effects of hydrogen bathing on exercise-induced oxidative stress and delayed-onset muscle soreness / 体力科学

Several studies have reported that molecular hydrogen (H₂) acts as a therapeutic medical gas owing to scavenging reactive oxygen species (ROS). However, little is known about effects of H₂ on exercise-induced oxidative stress. The purpose of this study was to investigate the effects of weekly hydrogen bathing on exercise-induced oxidative stress and delayed-onset muscle soreness (DOMS). Nine healthy and active young men participated in this study, and each subject performed hydrogen bathing trial and placebo bathing trial in a crossover design. The subjects performed downhill running (8 % decline) at 75 % peak oxygen uptake (VO₂peak) for 30 min, and each subjects conducted hydrogen or placebo bathing for 20 min, respectively, 1-6 days after downhill running. Before and after exercise, we measured visual analogue scale (VAS) and collected blood samples (Pre- and 5 min, 60 min after the end of bathing, 1day, 2days, 3days, 7days after downhill running). Blood sample analyses include creatine kinase (CK), myoglobin (Mb), malondialdehyde (MDA), reactive oxygen metabolites (d-ROMs), biological antioxidant potential (BAP), myeloperoxidase (MPO), interleukin-6 (IL-6), interleukin-17a (IL-17a) and lactate concentrations. Weekly hydrogen bathing had no effects of exercise-induced oxidative stress and muscle damage. On the other hand, hydrogen bathing significantly reduced DOMS (VAS) 1 and 2days after downhill running (p=0.033). These findings suggest that hydrogen bath after downhill exercise can be effective for reduction of DOMS.

Delayed-Onset Paraplegia after Type A Dissection Repair / 日本心臓血管外科学会雑誌

We present the case of a 53-year-old man who developed delayed-onset paraplegia after type A dissection repair. He was referred to our hospital with a diagnosis of type A dissection, for which we performed total arch replacement. Although the patient started walking on postoperative day 4, on postoperative day 5, he developed lower limb paraplegia without any precipitating episodes. Computed tomography showed that the false lumen was thrombosed in the upper descending thoracic aorta and hypoperfused in the lower descending thoracic aorta. The cerebrospinal fluid was immediately drained to maintain the spinal pressure at 14 cm H₂O for four days. Although the patient began to move his legs immediately after treatment, he remained paraparetic, and was transferred to another rehabilitation hospital on postoperative day 40.

Effects of shortening and lengthening resistance exercise with low-intensity on physical fitness and muscular function in senior adults / Efeitos de exercícios resistivos de encurtamento e alongamento, em baixa intensidade, sobre condicionamento e função muscular em adultos sênior

OBJECTIVE: To identify effects of shortening and lengthening low-intensity resistance exercise together with aerobic exercise on physical fitness and muscular strength in senior adults. METHOD: Seventeen males (58-72yrs) and sixteen females (58-68yrs) participated in this study: seven male and six female as control subjects, ten male and ten female as exercise subjects: these subjects completed an 8-week training program (two times/week) consisting of 15 minutes of aerobike exercise at 50% of VO2max and six shortening-lengthening resistance exercises (3 exercises for upper body and 3 exercises for lower body). The subjects exercised resistance training (5 sec for shortening, 5 sec for lengthening) at 50% of one repetition maximum. Primary outcome measures included physical fitness tests (grip strength, sit-ups, sit-and-reach, 6 minutes of walking, single-leg balance test with open eyes), timed up-and-go test (UP&GO), and one repetition maximum of the same six exercises. This study examined joint angle of knee flexion and elbow flexion, visual analog scale, and muscular strength test to identify delayed onset muscle soreness. RESULTS: The resting blood pressures in both exercising groups were significantly decreased after 16 sessions of exercise intervention (p < 0.05). The training group significantly increased muscular strength and improved physical fitness, UP&GO, and one repetition maximum of 6 resistance exercises (p < 0.05). The combined exercise did not induce delayed onset muscle soreness. CONCLUSION: The present study showed that the combined shortening and lengthening resistance training with aerobic exercise in senior male and female adults was effective in decreasing blood pressure and increasing muscular strength and physical fitness.

OBJETIVO: Identificar os efeitos de encurtamento e alongamento através de exercício resistivo de baixa intensidade, juntamente com exercício aeróbico sobre a aptidão física e força muscular em idosos. MÉTODO: Dezessete homens (58-72 anos) e dezesseis mulheres (58-68 anos) participaram deste estudo: 7 homens e 6 mulheres como controles, 10 homens e 10 mulheres submetidos aos exercícios: um programa de treinamento bissemanal de 8 semanas, consistindo em dez minutos de aerobike a 50% do VO2max e seis exercícios de alongamento/encurtamento (três para membros superiores e três para membros inferiores). Cada exercido foi repetido quinze vezes (50% de Uma-Repetição-Máxima - 1RM) com 5 seg para encurtamento e 5 seg para alongamento). Foram medidos: força de preensão, sit-ups, sentar-e-alcançar, 6 minutos de caminhada, teste de equilíbrio de single-leg com os olhos abertos), teste up-and-go (UP & GO), 1RM dos mesmos seis exercícios, ângulo articular de flexão do joelho e flexão de cotovelo, escala analógica visual, e teste de força muscular para identificar dor muscular tardia. RESULTADOS: A pressão arterial em repouso do grupo exercício apresentou diminuição significativa após as 16 sessões de exercício. O grupo de treinamento aumentou significativamente a força muscular com melhoria da aptidão física, UP & GO, e uma repetição máxima de 6 exercícios de resistência. O exercício combinado não induziu dor muscular tardia. CONCLUSÃO: O presente estudo mostrou que o encurtamento/alongamento combinado com o exercício aeróbico em adultos idosos do sexo masculino e feminino foi eficaz para a diminuição da pressão arterial e aumento de força muscular e aptidão física.

Delayed-Onset Interface Fluid Syndrome after LASIK Surgery in Traumatic Hyphema

A 50-year-old female was referred to our clinic with visual disturbance, hyphema and increased intraocular pressure (IOP) in her right eye 7 days after experiencing blunt trauma in that eye. She had undergone uncomplicated laser in situ keratomileusis (LASIK) on both eyes 10 years earlier. At initial examination, the best corrected visual acuity (BCVA) in her right eye was counting fingers at 2 feet with no correction. Central Goldmann applanation tonometry (GAT) showed an IOP of 7 mm Hg. Peripheral digital tonometry showed the IOPs in her right eye superiorly, nasally, temporally, and inferiorly were 36 mm Hg, 35 mm Hg, 34.5 mm Hg and 36.5 mm Hg, respectively. Slit-lamp examination showed diffuse epithelial and stromal edema and a blood clot 1 mm in height in the anterior chamber. Spectral domain scanning laser ophthalmoscope/optical coherence tomography (SD-SLO/OCT) images showed a pocket of fluid between the LASIK flap and the underlying stroma. The patient was started on anti-inflammatory agent and IOP lowering agents. After 15 days of treatment, IOP measured with GAT was 10 mm Hg, slit-lamp examination showed that epithelial and stromal edema had disappeared, and OCT showed no fluid between the corneal flap and stroma.

Métodos de recuperação pós-exercício / Post-exercise recovery methods

A recuperação pós-exercício é de extrema relevância dentro de todo programa de condicionamento físico, tanto para praticantes e atletas, como para técnicos e diversos profissionais ligados à área da saúde. Nesse sentido, o conhecimento a respeito da recuperação pós-exercício e dos vários métodos utilizados com intuito de acelerar o processo de recuperação (para suportar mais frequentes e/ou maiores cargas de treinamento com mais qualidade) torna-se essencial. Dessa forma, as intervenções utilizadas de forma profilática e/ou terapêutica com o intuito de amenizar os efeitos negativos das lesões musculares causadas pelo exercício físico e, assim, otimizar a recuperação são de grande interesse para pesquisadores, técnicos e atletas. Em vista disso, o objetivo da presente revisão de literatura é reunir informações que permitam descrever as respostas fisiológicas frente aos métodos de recuperação pós-exercícios, com a finalidade de melhorar tanto o processo de treinamento físico como o rendimento.

Post-exercise recovery is a key factor within every physical training program for athletes and non-athletes alike, as well as coaches and health professionals. Thus, knowledge on the post-exercise recovery process and the efficacy of the recovery modalities in enhancing between-training session (to increase training frequency and/or training loads qualitatively) is essential. Therefore, prophylactic or therapeutic interventions that might reduce the negative effects of exercise-induced muscle damage, thereby speeding recovery, are of great interest to researchers, coaches and athletes. As such, the purpose of this review was to describe the physiological responses to post-exercise recovery modalities currently used to aid athlete recovery during the training process, and consequently enhance performance.

Delayed-onset bilateral abducens paresis after head trauma.

Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

Delayed onset renal failure following multiple bee stings.

Bee sting is an uncommon pediatric emergency encountered worldwide and capable of causing acute renal failure, multiorgan dysfunction and occasionally death. We had a two year male child who suffered from multiple bee stings and delayed onset acute renal failure, survived following peritoneal dialysis.

Delayed Brachial Artery Occlusion after Humeral Shaft Open Fracture: A Case Report

Although vascular injury after humeral fracture is very rare, it is a complication that has serious sequelae. It has been associated with proximal humeral fracture or shoulder dislocation in adults and humeral supracondylar fracture in children. However, delayed brachial artery occlusion after humeral shaft fracture has never been reported worldwide. Nevertheless, delayed brachial artery occlusion after humerus shaft fracture has the potential to cause serious complications in the short term as well as long term; therefore, it is essential to provide accurate diagnosis and prompt treatment. We report a case of delayed brachial artery occlusion after humeral shaft open fracture that was successfully treated with early diagnosis as well as effective treatment.

Delayed Onset of Thoracic SCIWORA in Adults

Spinal cord injury (SCI) without radiographic abnormality (SCIWORA) is estimated to account for 1-9% of the occurrence of SCI. Of these, cervical SCIWORA in children is common, but thoracic SCIWORA delayed onset in adult is much less common. We experienced a case of 38-years old male patient with lower extremity weakness; he had fallen down a week earlier before the investigation. At the time of admission, motor grade was 4 with voiding incontinence and ambulated with cane. He presented progressive weakness from G4 to G3 and hypoesthesia was below T8 dermatome and ambulated with wheelchair. Whole spine and lumbar MRI findings showed no abnormality and electrodiagnostic findings showed normal NCS, however, abnormal SEP on both the tibial nerves. After steroid therapy and proper rehabilitation program for 2 weeks, lower extremity strength was improved from G4 to G3, voiding was continent, and ambulation reached cane gait.

A Case of Delayed-onset Wallenberg's Syndrome following Cervical Spine Fracture coexisting with suspected Conversion Disorder / The Japanese Journal of Rehabilitation Medicine

We experienced a case of delayed-onset Wallenberg's syndrome following cervical spine fracture coexisting with suspected conversion disorder. A 69-year-old man was involved in a traffic accident, and was admitted to our rehabilitation unit for the purpose of posttraumatic rehabilitation. At first, he complained of right occipital and nuchal pain. But his complaints changed to ataxia, dysphagia and a suspected brainstem lesion four months after the accident. His brainstem MRI showed a small ischemic lesion in the right dorsolateral area of the medulla oblongata. The long time lag between the original traumatic event and his changing complaints made the diagnosis difficult. Accordingly, rehabilitation assessment and conventional rehabilitation approaches were prepared for all of his symptoms. The dysphagia and ataxia were gradually reduced and the hemiparesis lessened and disappeared. A couple of points were suggested by this case. The first is “We must never overlook a change of neurological symptom masked as conversion disorder, and never deny what the patient says without careful listening.” The second is “We should offer the patient a conventional rehabilitation program without the option for malingering and falsification. This case might suggest that our attitude toward so-called gray-zone cases has an influence on the functional/social prognosis.

On the Polymodal Receptor with Characteristics Suitable for a Receptor that Transmits Acupuncture / Moxibustion Stimuli / 日本東洋医学雑誌

Muscular unmyelinated (C-) fibers are supposed to be the afferent limb of acupuncture effects. Of muscular unmyelinated afferent receptors, polymodal receptors are considered to be important because of their sensitivities to moderate mechanical and strong thermal stimulations and to algesic substances. I would like to introduce response characteristics of muscular polymodal receptors, especially on their sensitization to mechanical stimulation.Polymodal receptors consist of 50% of mechano-sensitive muscular C-fiber receptors in rats. Comparing with non-polymodal receptors that would not respond to heat stimulation, the mechanical threshold of the polymodals is not different, but their discharge rate is lower. The response threshold to heat is around 41°C. The mechanical response of this receptor is augmented by bradykinin, prostaglandins, histamine and acid. Nerve growth factor (NGF) is one of neurotrophic factors that is essential for the development and survival of thin-fiber afferents and their differentiation during ontogeny. In adulthood NGF is produced in inflammatory cells (macrophages, mast cells, etc) and fibroblasts, and sensitizes nociceptors to heat and mechanical stimulations, and plays an important role in hyperalgesia. It is reported that intramuscular injection of NGF into humans induced mechanical hyperalgesia.Recently we found up-regulation of NGF in the muscle in non-inflammatory condition, namely in delayed onset muscle soreness that appears after strenuous and unaccustomed exercise (delayed onset muscle soreness). Up-regulation of NGF in the muscle starts about 12 hrs after exercise, and it lasts up to 2 days after exercise. Anti-NGF antibody injection to the muscle on the 2nd day after exercise, reversed mechanical hyperalgesia. Thus it is concluded that sensitization of C-fiber receptors by NGF to mechanical stimulation results in mechanical hyperalgesia. Because there is no sign of inflammation in the muscle, cells that produce NGF cannot be inflammatory cells, and muscle cells themselves, blood vessel cells or connective tissue cells might produce NGF. In addition, the majority of sensory receptors that are sensitized after exercise are heat sensitive, that means they are mostly polymodal receptors. Because many of muscle pain conditions are not inflammatory, non-inflammatory production of NGF in the muscle observed in the delayed onset muscle soreness raises a possibility that NGF is produced in other muscle pain conditions, and sensitizes muscle nociceptors to result in muscle hyperalgesia. This point must be clarified in future.