Assessment Of Respiratory Muscle Strength Using Maximal Inspiratory Pressure And Maximal Expiratory Pressure In Patients With Chronic Obstructive Pulmonary Disease: A Study On Indian Population

Chronic Obstructive Pulmonary Disease (COPD) is a common disease seen in Indian population. It is most commonly seen in the lower strata where beedi and cigarette smoking is most prevalent and starts at an early age. Smoke arising from cooking stoves during cooking is the cause of COPD in females. Though the number of males suffering from COPD is much larger than females, we observed a proportionate number of females in all age group suffering from this disease. It is the leading cause of mortality and should be studied in detail so as to avoid complications in such patients. We have studied the strength of respiratory muscles in such patients using newer techniques like Maximal Inspiratory Pressure (MIP) and 7 8 Maximal Expiratory Pressure (MEP). Terzano et al. (2008) and Khalil et al.(2014) have carried out similar studies in COPD patients. We have checked correlation between anthropometric measurements and strength of respiratory muscles, correlation between airway resistance and muscle strength and also compared the sensitivity and specificity of this technique using ROC (receiver operating Curve) as compared to the age old spirometry. These techniques may help in monitoring the status of COPD patients and assessing muscle weakness.

Molecular cloning and characterization of CMK from Artemisia annua / 中国中药杂志

Artemisinin is a preferred medicine in the treatment of malaria. In this study, AaCMK, a key gene involved in the upstream pathway of artemisinin biosynthesis, was cloned and characterized from Artemisia annua for the first time. The full-length cDNA of AaCMK was 1 462 bp and contained an ORF of 1 197 bp that encoded a 399-anomo-acid polypeptide. Tissue expression pattern analysis showed that AaCMK was expressed in leaves, flowers, roots and stems, but with higher expression level in glandular secretory trichomes. In addition, the expression of AaCMK was markedly increased after MeJA treatment. Subcellular localization showed that the protein encoded by AaCMK was localized in chloroplast. Overexpression of AaCMK in Arabidopsis increased the contents of chlorophyll a, chlorophyll b and carotenoids. These results suggest that AaCMK plays an important role in the biosynthesis of terpenoids in A. annua and this research provids a candidate gene that could be used for engineering the artemisinin biosynthesis.

Prediction of Motor Recovery Using Quantitative Parameters of Motor Evoked Potential in Patients With Stroke

OBJECTIVE: To investigate the clinical significance of quantitative parameters in transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP) which can be adopted to predict functional recovery of the upper limb in stroke patients in the early subacute phase. METHODS: One hundred thirteen patients (61 men, 52 women; mean age 57.8±12.2 years) who suffered faiarst-ever stroke were included in this study. All participants underwent TMS-induced MEP session to assess the corticospinal excitability of both hand motor cortices within 3 weeks after stroke onset. After the resting motor threshold (rMT) was assessed, five sweeps of MEP were performed, and the mean amplitude of the MEP was measured. Latency of MEP, volume of the MEP output curve, recruitment ratios, and intracortical inhibition and facilitation were also measured. Motor function was assessed using the Fugl-Meyer Assessment scale (FMA) within 3 weeks and at 3 months after stroke onset. Correlation analysis was performed between TMS-induced MEP derived measures and FMA scores. RESULTS: In the MEP response group, rMT and rMT ratio measures within 3 weeks after stroke onset showed a significant negative correlation with the total and upper limb FMA scores at 3 months after stroke (p<0.001). Multiple regression analysis revealed that FMA score and rMT ratio, but not rMT within 3 weeks were independent prognostic factors for FMA scores at 3 months after stroke. CONCLUSION: These results indicated that the quantitative parameter of TMS-induced MEP, especially rMT ratio in the early subacute phase, could be used as a parameter to predict motor function in patients with stroke.

Predictive equations for respiratory muscle strength according to international and Brazilian guidelines / Equações de predição para a força muscular respiratória segundo diretrizes internacionais e brasileiras

Background: The maximum static respiratory pressures, namely the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), reflect the strength of the respiratory muscles. These measures are simple, non-invasive, and have established diagnostic and prognostic value. This study is the first to examine the maximum respiratory pressures within the Brazilian population according to the recommendations proposed by the American Thoracic Society and European Respiratory Society (ATS/ERS) and the Brazilian Thoracic Association (SBPT). Objective: To establish reference equations, mean values, and lower limits of normality for MIP and MEP for each age group and sex, as recommended by the ATS/ERS and SBPT. Method: We recruited 134 Brazilians living in Belo Horizonte, MG, Brazil, aged 20-89 years, with a normal pulmonary function test and a body mass index within the normal range. We used a digital manometer that operationalized the variable maximum average pressure (MIP/MEP). At least five tests were performed for both MIP and MEP to take into account a possible learning effect. Results: We evaluated 74 women and 60 men. The equations were as follows: MIP=63.27-0.55 (age)+17.96 (gender)+0.58 (weight), r2 of 34% and MEP= - 61.41+2.29 (age) - 0.03(age2)+33.72 (gender)+1.40 (waist), r2 of 49%. Conclusion: In clinical practice, these equations could be used to calculate the predicted values of MIP and MEP for the Brazilian population. .

Contextualização: A medida das pressões respiratórias estáticas máximas (pressão inspiratória (PImáx) e pressão expiratória máxima (PEmáx)) refletem a força dos músculos respiratórios. Essas medidas são simples, não invasivas e têm valores diagnóstico e prognóstico estabelecidos. Este é o primeiro estudo que avaliou pressões respiratórias máximas com a população brasileira realizado de acordo com as recomendações propostas pela American Thoracic Society e European Respiratory Society (ATS/ERS) e pela Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). Objetivo: Estabelecer equações de referência, valores médios e limites inferiores de normalidade para a PImáx e a PEmáx para cada faixa etária e gênero, conforme as recomendações da ATS/ERS e da SBPT. Método: Foram recrutados 134 brasileiros residentes em Belo Horizonte, MG, Brazil, com idade entre 20-89 anos, com prova de função pulmonar e índice de massa corporal dentro da normalidade. Foi utilizado um manovacuômetro digital que operacionalizou a variável pressão média máxima. Para a PImáx e a PEmáx, foram realizadas, pelo menos, cinco manobras, considerando o efeito aprendizado. Resultados: Foram avaliados 74 mulheres e 60 homens. As equações propostas foram: PImáx=63,27-0,55 (idade)+17,96 (sexo)+0,58 (peso), r2=34% e PEmáx=-61,41+2,29 (idade)-0,03 (idade2)+33,72 (sexo)+1,40 (cintura), r2=49%. Conclusão: As equações resultantes deste estudo poderão ser utilizadas na prática clínica para cálculo de valores preditos para PImáx e PEmáx na população brasileira. .

The masseter motor-evoked potential after transcranial magnetic stimulation in patients with sleep bruxism / 实用口腔医学杂志

Objective:To study the masseter motor evoked potential(MEP)in patients with sleep bruxism(SB)and in healthy con-trols.Methods:30 subjects with SB and 30 healthy controls were included.MEPs were obtained by transcranial magnetic stimulation (TMS).Tests were done during daytime when the subjects were awake.The data were statistically analysed.Results:In the patients AMT was 55(52,55)%,latency of c-MEP (6.7 ±1.3)ms,the amplitude of c-MEP 0.19(0.15,0.29)mV,latency of r-MEP (2.3 ±0.4)ms,the central conduction time(CCT)4.4(3.3,5.2)ms.In the control subjects AMT was 52(52,55)%,latency of c-MEP (6.4 ±0.7)ms,the amplitude of c-MEP 0.23(0.17,0.28)mV,latency of r-MEP (2.4 ±0.4)ms,CCT 4.0 (3.4,4.4) ms.No significant difference was found between the 2 groups in the measurements evoked by TMS.Conclusion:The MEP after TMS in patients with SB is similar to that of healthy subjects,indicating that the excitability of the cortical motor system is not changed in bruxism subjects,at least when evaluated by TMS.

Role of exercise and nutrition on cardiopulmonary fitness and pulmonary functions on residential and non-residential school children.

Physical fitness is the prime criterion for survival and to lead a healthy life. Our aim is to find out effect of exercise and nutrition on physical fitness on growing children with scientific records. The present study was designed on healthy school children of a Residential-Sainik (100) and Non-Residential (100) school children (12-16 yrs) of Bijapur. To evaluate cardiopulmonary fitness parameters included are VO2 Max (ml/kg/min) and Physical Fitness Index (PFI %). Harvard Step Test determined VO2 Max and PFI. Also recorded pulmonary function parameters like Forced Expiratory Volume in 1 sec (FEV1 in %) by recording spirometry. Peak Expiratory Flow Rate (PEFR in L/Min) by Peak flow meter and Maximal Expiratory Pressure (MEP in mmHg) by modified Black’s apparatus. We found statistically significant higher values (p=0.000) of VO2 Max, PFI, FEV1, PEFR and MEP in residential school children compared to nonresidential school children higher. So, our study shows that regular exercise and nutritious food increase the cardiopulmonary fitness values and pulmonary functions in Residential school children.

Isoprenoid biosynthesis in the erythrocytic stages of Plasmodium falciparum

The development of new drugs is one strategy for malaria control. Biochemical pathways localised in the apicoplast of the parasite, such as the synthesis of isoprenic precursors, are excellent targets because they are different or absent in the human host. Isoprenoids are a large and highly diverse group of natural products with many functions and their synthesis is essential for the parasite's survival. During the last few years, the genes, enzymes, intermediates and mechanisms of this biosynthetic route have been elucidated. In this review, we comment on some aspects of the methylerythritol phosphate pathway and discuss the presence of diverse isoprenic products such as dolichol, ubiquinone, carotenoids, menaquinone and isoprenylated proteins, which are biosynthesised during the intraerythrocytic stages of Plasmodium falciparum.

Reduction in lung functions in type-2 diabetes in Indian population : Correlation with glycemic status.

The purpose of this study was to evaluate pulmonary functions in patients with Type-2 diabetes mellitus and to determine their correlation with glycemic status of diabetes in Indian population. Forty Type-2 diabetic patients, aged 30-60 years, with diabetic duration of 1-20 years, were included in the study. FVC, FEV1, & FEV1% are recorded by Benedict’s Roth spirometer. PEFR and MEP were recorded by Wright’s Peak flow meter & Modified Black’s apparatus. Glycemic status of subjects was determined by FBS & PPBS by Glucose oxidase & peroxidase methods. And results were analyzed by calculating Mean±SD, using Student’s t test, and Pearson correlation. All the respiratory parameters are reduced in Type- 2 diabetic patients compared to control of which FEV1, FEV1%, & MEP show very highly significant reduction (P=0.000). Lung functions are negatively correlated with glycemic status & duration of diabetes. (r = – 0.390, & –0.342) Reduction in dynamic lung functions and its negative correlation to glycemic status might be due to respiratory muscle weakness as indicated by highly significant reduction in MEP. Hence strict glycemic control and breathing exercises to strengthen the respiratory muscles may improve lung function in diabetics.

Presença de Sarcocysits spp. em marsupiais da espécie Didelphis albiventris na região sul do estado do Rio Grande do Sul, Brasil

Este estudo avaliou o grau de infecção por Sarcocystis spp. em marsupiais do gênero Didelphis spp., conhecidospopularmente por gambás, no município de Bagé, na região sul do estado do Rio Grande do Sul (RS). Este parasito é oagente causador da Mieloencefalite Protozoária Equina (MEP), sendo que neste município estão localizados importantescriatórios de cavalos Puro-Sangue Inglês, demonstrando a importância deste estudo na região. O gambá atua comohospedeiro definitivo do parasito e elimina oocistos juntamente com as fezes. Os equinos infectam-se ao ingerir alimentoscontaminados por fezes de gambás. Para o estudo, foram analisados 19 marsupiais da espécie Didelphis albiventris.Foram realizadas raspagens das três secções do intestino delgado dos gambás para avaliação de lesões macroscópicase histopatológicas, como também para o isolamento e identificação de Sarcocystis spp. Na avaliação histopatológica,observou-se a presença de células inflamatórias, infiltrado de eosinófilos e áreas hemorrágicas, caracterizando enterite.Nos 19 (100%) animais necropsiados e examinados, foi observada a presença de Sarcocystis spp., e em um (5,3%) animalfoi isolado Sarcocystis neurona.

Analysis of Intraoperative Neurological Complications in High-Risk Spinal Surgery with the Use of Motor Evoked Potential Monitoring

STUDY DESIGN: This is retrospective study. OBJECTIVES: To evaluate the risk of operative techniques using Motor Evoked Potential (MEP) in high-risk spinal surgery. SUMMARY OF LITERATURE REVIEW: There are few studies regarding the evaluation of operative techniques by MEP. MATERIALS AND METHODS: We studied 33 cases that had MEP during surgery from July 2007 to March 2009. Diagnoses included post-traumatic kyphosis (PTK) in eight cases, congenital deformity in eight cases, degenerative lumbar deformity in eight cases, ankylosing spondylitis (AS) in three cases, spinal tumor in three cases, adjacent segmental disease in two cases, and post-surgical kyphosis in one case. Posterior vertebral column resection (PVCR) and pedicle subtraction osteotomy (PSO) were performed in 27 cases (81.8%) and, in the others, posterior decompression with discectomy was performed. We analyzed the risk of operative techniques and evaluated the MEP. RESULTS: MEP showed abnormal signal change in five cases (PVCR: one case, compression and distraction: four cases). The AS case did not demonstrate neurological change after surgery. Though the PTK on T12 operated by PVCR case did not show an abnormal MEP result, neurological change was observed postoperatively. The sensitivity, specificity, percent of false negatives, and percent of false positives of MEP were 80.0%, 96.4%, 20.0%, and 3.6%, respectively. CONCLUSIONS: MEP monitoring is a useful method to detect neurological injury during high-risk spinal surgery with satisfactory specificity. For low sensitivity and a high false negative rate, increased monitoring of cases and continuous follow-up is needed. In conclusion, compression and distraction and PVCR are high-risk techniques in kyphotic deformity correction.

Killing effects of PNP-CD chimeric suicide gene vector on HCC cells / 中华肝胆外科杂志

Objective To investigate the cytotoxic effects and mechanism of PNP-CD chimeric gene vector originated from PNP/MeP-dR system on HCC cells. Methods The fusion suicide gene PNP-CD obtained by site directed mutagenesis technique was subcloned into pcDNA3.0 to construct a eukaryotic expression vector containing a chimeric gene, pcDNA3.0/ PNP-CD. After being identified by recombinant enzyme, PCR and subsequent sequencing, it was transfected into HepG2 cells by liposome-mediation method. The G418-resistant cellular clone with stable transfection of pcDNA3.0/PNP-CD, HepG2/PNP-CD was established by selection. The expression of PNP-CD gene was also verified by RT-PCR and Western blotting. The curve of cellular growth was assayed by Trypan blue exclusion. The cellular sensitivity of HepG2/PNP-CD to its specific prodrugs and its bystander effects were also assayed by MTT method. Results The chimeric gene, PNP-CD, was inserted into pcDNA3.0 correctly, and the stable expression of pcDNA3.0/PNP-CD in HepG2 cells was confirmed.This cellular clone was highly sensitive to its corresponding prodrugs. It was indicated that its bystander effects with the synergetic treatment of its specific prodrugs were substantially higher than those caused by the same vector with the administration of only a single prodrug, MeP-dR. Conclusion The bi-functional fusion suicide gene vector, pcDNA3.0/PNP-CD, yields powerful cytotoxic effects on HCC cells in the presence of the synergetic treatment of its specific prodrugs, which would be a high-performance therapeutic vector in gene therapy for liver cancer.

Facilitation of Cortical Excitability by Action Related Sentence

OBJECTIVE: To investigate the effect of action related visual and auditory stimuli on the motor evoked potential (MEP) of hand. METHOD: Right handed fifteen healthy adults without neurological deficit were included. Visual lingual stimulation was given on the computer monitor with the sentence and auditory lingual stimulation was given 10 repetitions of the above sentence using computer speaker with eyes closed. MEPs from transcranial and transcervical magnetic stimulation were recorded on the abductor pollicis brevis of the right hand. RESULTS: The latency of MEPs was shortened and the amplitude of MEPs with transcranial magnetic stimulation after lingual stimulation (p<0.05). However, the latency and amplitude of with transcervical stimulation did not show significant changes. CONCLUSION: Cortical excitability was enhanced by action related visual or auditory stimuli. Exercise accompanied by visual or auditory lingual stimulation rather than simple exercise might be useful for facilitating cortical excitability.

Prediction of Clinical Outcomes in Patients with Acute Ischemic Stroke by Measurements of Motor Evoked Potentials / 대한뇌혈관외과학회지

OBJECTIVE: The integrity of the motor pathways can be assessed objectively and quantitatively by measuring the motor evoked potentials (MEPs). However, the early prognostic application of MEPs for assessing the motor and functional recovery of patients with acute ischemic stoke has yielded contradictory results. Therefore, we assessed the value of MEPs for predicting the clinical outcomes of acute ischemic stroke patients. METHODS: Thirty three stroke patients with different degrees of hemiparesis were enrolled in this study. The stroke severity and outcome were assessed using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) at admission and at 3 months. The MEPs were measured at the adductor pollicis brevis and adductor hallucis muscles and the relationships between the NIHSS, the mRS and the MEP findings were analysed. RESULTS: In the acute phase of stroke, the presence of MEPs in the upper or lower extremities was correlated with a better clinical outcome (NIHSS: 9.12+/-5.86->2.81+/-1.47, mRS: 2.81+/-1.47->1.62+/-1.31) than the absence of an MEP in at least one extremity (NIHSS: 11.47+/-5.53->8.88+/-6.02, mRS: 3.70+/-1.31->2.94+/-1.67). Especially, there was significant clinical improvement after 3 months in the large territorial infarction patients according to the presence of MEPs. The sensitivity of the presence of MEPs for predicting clinical improvement (motor grade> or =III) was 71.4%, while the specificity was 72.7% in severe hemiplegic patients (motor grade

The Correlation of Hemiplegic Upper Limb Recovery with SEP and MEP in Subjects with a Stroke

OBJECTIVE: To investigate whether combined somatosensory evoked potential (SEP) and motor evoked potential (MEP) would provide more reliable data in predicting hemiplegic upper limb function in subjects with an acute stroke. METHOD: We enrolled 59 subjects (34 males; mean age, 56.7 years) with stroke involving the middle cerebral artery (MCA) territory. The SEP and MEP were recorded within a month from the onset time of the stroke. Simultaneously, the manual function test (MFT) and the self-care in functional independence measure (Fsc) were selected for evaluation (MFT-Initial and Fsc-Initial). The MFT and Fsc were assessed every other week until improvement was no longer observed (MFT-Final and Fsc-Final). The subjects were divided into two groups according to SEP and MEP results. With the results from the two methods combined, the subjects were divided into three groups: responses in both, responses in only one, and responses in none. Data were analyzed to find the correlation of MFT or Fsc with the results of SEP and MEP combined and individually. RESULTS: Both SEP and MEP had a correlation with MFT- Initial and MFT-Final, but not with Fsc-Initial and Fsc-Final (p<0.05), whether combined or not. However, combining the SEP and MEP resulted in a stronger correlation with MFT-Initial and MFT-Final. CONCLUSION: Combining SEP and MEP is a more effective means to detect the recovery of motor weakness for hemiplegic upper limb in stroke subjects, although SEP or MEP alone has a correlation with recovery as well.

Changes of Calcitonin Gene-related Peptide and Acetylcholine Esterase in Motor End Plates after Spinal Cord Injury in Adult Rats / 中国康复理论与实践

@#Objective To explore the degeneration of motor end plates (MEP) by observing the expression of calcitonin gene-relative peptide (CGRP) and acetylcholine esterase (AChE) in the MEP after different types of spinal cord injury. Methods 60 adult female Wistar rats were randomly assigned to 3 groups: sham group, completely transection group and contusion group. The content of AChE in the MEP was detected with Karnovsky-Roots staining and the expression of CGRP was then determined with immunohistochemistry. Results The content of both AChE and CGRP significantly decreased after either type of spinal cord injury. However, their activity gradually recovered to the normal level in the contusion group, but not in the transection group. Moreover, the changes of CGRP occurred earlier than those of AChE. Conclusion The motor end plate degenerates differently after different kinds of spinal cord injury in adult rat, CGRP and AChE are related to the degeneration of MEP.

Experimental Studies on PNP Suicide Gene Therapy of Hepatoma / 华中科技大学学报（医学）（英德文版）

To investigate the killing effect of PNP/MeP-dR suicide gene system on hepatoma cells,pcDNA3. 0/PNP, an eukaryotic expression vector harboring E. coli PNP gene, was transfected into human hepatoma HepG2 cells by liposome-mediated method. A HepG2 cell line with stable PNP gene expression, HepG2/PNP, was established with presence of G418 selection. The cell growth curves were determined with trypan blue staining. The sensitivity of HepG2/PNP to MePdR and bystander effects were assayed by MTT and FCM methods. The enzymatic activity of the product of PNP gene was determined by HPLC method. The cytotoxic effects of MeP-dR on HepG2/PNP cells were obvious (IC50 =4.5μmol/L) and all HepG2/PNP cells were killed 4 days after the treatment with 100μmol/L MeP～dR. In mixed cultures containing increasing percentages of HepG2/PNP cells, total population killing was demonstrated when HepG2/PNP cells accounted for as few as 5% of all HepG2 cells 8 days after the treatment with 100μmol MeP-dR. Highpressure liquid chromatography (HPLC) demonstrated that the PNP enzyme could convert MePdR into 6-MP. PNP/MeP-dR suicide gene system had an advantage over traditional suicide gene systems for hepatoma gene therapy. Our e results suggest that high-level bystander effects of this system result in significant anti-tumor responses to hepatoma gene therapy, especially in vivo.

Relationship of the change of calcitonin gene-related peptide and degeneration of the motor endplate after spinal cord injury in the rat / 中国康复理论与实践

@#ObjectiveTo observe changes of calcitonin gene related peptide (CGRP) and aetylcholinesterase (AChE) in motor endplate (MEP) after complete spinal cord injury (SCI) in the rat.MethodsSCI model of Wistar rats were established by transecting T10 spinal cord completely. The venters of the tibial anterior muscle were taken at 1, 2, 4 and 8 weeks postoperatively to carry out the experiment.The changes of CGRP and AChE in the MEP were investigated with immunohistochemical test.ResultsAfter complete SCI, the quantity and distribution of CGRP decreased in MEP of 1-week sample, and the changes of AChE were observed until 4-week sample, and although the staining was light and sparse, CGRP and AChE existed in MEP during 2 months postoperatively.ConclusionThere is degeneration of MEP in skeletal muscle after upper motor neuron injury; CGRP and AChE are related to the degeneration of MEP; CGRP test can show the changes of MEP earlier.

Prognostic Factors Affecting the Results of the Surgery for Cervical Spondylotic Myelopathy / 대한척추외과학회지

STUDY DESIGN: This retrospective study was designed to investigate and define the factors affecting the results of surgery for cervical spondylotic myelopathy. OBJECTIVE: This study was performed in an attempt to investigate and define the factors affecting the results of surgery for cervical spondylotic myelopathy. SUMMARY OF THE LITERATURE REVIEW: There have been few studies about the factors affecting the results of surgery for cervical myelopathy, including MEP (Motor evoked potential) studies and gait analysis, so we investigated the factors that affect the results of surgery for cervical myelopathy. MATERIALS AND METHODS: We retrospectively studied 59 cervical spondylotic myelopathy patients who underwent operation from Nov. 1994 to Oct. 2002. We analyzed 13 prognostic factors: age, disease duration, the pre-op JOA score, the pre-op. AP canal diameter, the Pavlov ratio, disease level, the AP and lateral cord diameter, the transverse area and the compression ratio at the level of the maximal cord compression on MRI, the cord signal changes on MRI, the MEP(Motor evoked potential) and the gait analysis. The mean follow up period was 29 months. The clinical results were evaluated according to the JOA score. Statistical analysis was performed using the Pearson correlation test, ANOVA and the Kruskal-Wallis test. RESULTS: The mean pre-op JOA score was 11.1 and the post-op. JOA score was improved to 14.7. The average recovery rate was 67%. The following factors were proved to an influence on the surgical outcomes: age and multiplicity of involvement, and the signal changes of the cord on MRI showed a negative correlation with the recovery rate. The pre-op JOA score, the mean sagittal diameter and the transverse area of the spinal cord at the level of maximum compression showed a positive correlation with the recovery rate. Spasticity on the gait analysis and central conduction block on MEP had an influence on the surgical outcomes. CONCLUSIONS: The prognostic factors affecting the results of surgery for cervical myelopathy are age, the pre-op JOA score, the disease level, the mean sagittal diameter and the transverse area of the spinal cord at the level of maximum compression, signal change of the cord on MRI, spasticity on the gait analysis and central conduction block on MEP.

CENTRAL FATIGUE DURING CONSTANT CADENCE PEDALING FOR 60 SECONDS-A TRANSCRANIAL MAGNETIC STIMULATION STUDY / 体力科学

Changes in the motor evoked potential (MEP) evoked by transcranial magnetic motor cortex stimulation (TMS) of rectos femoris (RF) and vastus lateralis (VL) was examined during constant cadence cycling tasks for 60 sec. Subjects were 11 normal male volunteers aged between 19 and 25 years. Pedaling load was set at 100% and 80% of the estimated optimal value for maximum anaerobic power output. For the low load task (LL task), the pedaling rate was set at half the value of the maximum pedaling rate with the load set at 80% of the optimal for maximum anaerobic power output. For the high load task (HL task), the pedaling rate was set such that the power was equivalent to the LL task.<BR>The route mean square of the electromyographic (EMG) activity amplitude tended to steeply increase during the latter half of the task. The magnitude of the increase in the RMS was significantly larger in the HL task than the LL task. The area of the MEP also tended to increase in both tasks, though the degree of the increase was significantly larger in the LL task than the HL task. The EMG silent period (SP) after the MEP tended to steeply increase just after the task initiation and to decrease in the latter half of the task in the HL task. However, in the LL task the facilitation of MEP was not found, but it showed a gradual decrease while performing the task. The duration of the MEP tended to increase in both tasks, though the degree of the increase in the VL was significantly larger in the LL task than the HL task. The linear regression analysis between the size of the MEP and the background EMG shows a significant positive correlation coefficient during isometric contraction, but not during the two types of cycling tasks.<BR>These results suggest that the neural circuit responsible for the MEP was controlled differentially during isometric contraction and constant cadence pedaling. Also it is likely that the mechanism of central fatigue differed depending on the cadence and or load in a task-dependent fashion irrespective of the same power output.

Effect of Voluntary Contraction in Motor Evoked Potential and Silent Period by Transcranial Magnetic Stimulation

OBJECTIVE: To determine the effects of the voluntary contraction of muscles and magnetic stimulation intensity on the motor evoked potential (MEP) and the silent period (SP). METHOD: We studied MEPs and SPs in opponens pollicis muscle in 30 healthy adults (male: 16, female: 14) while varying the amount of the voluntary contraction and the stimulation intensity. We analyzed MEPs and SPs in relation to sex, recording site, opposition power and height. RESULTS: 1) During the contraction, the latencies of MEP were significantly shorter than during the relaxation. 2) The amplitudes of MEP reached plateau at 30% of maximal voluntary contraction and increased with increment of stimulation intensity without limitation. The amplitudes of MEP of right hand were bigger than left hand. There were no significant differences according to sex and recording site. 3) The durations of SP were directly proportional to the degrees of voluntary contraction and the stimulation intensity. CONCLUSION: Transcranial magnetic stimulation should be performed under the same voluntary contraction and magnetic stimulation intensity.