Validity of temporo-spatial characteristics of gait as an index for fall risk screening in community-dwelling older people.

[Purpose] This study aimed to identify kinematic gait indicators for a fall risk screening test through quantitative comparisons of gait characteristics measured using mobile inertial sensors between faller and non-faller groups in a population of community-dwelling older people. [Participants and Methods] We enrolled 50 people aged ≥65 years who used long-term care prevention services, interviewed them to determine their fall history during the past year, and divided them into faller and non-faller groups. Gait parameters (velocity, cadence, stride length, foot height, heel strike angle, ankle joint angle, knee joint angle, and hip joint angle) were assessed using the mobile inertial sensors. [Results] Gait velocity and left and right heel strike angles were significantly lower and smaller, respectively, in the faller versus non-faller group. Receiver operating characteristic curve analysis revealed areas under the curve of 0.686, 0.722, and 0.691 for gait velocity, left heel strike angle, and right heel strike angle, respectively. [Conclusion] Gait velocity and heel strike angle during gait assessed using mobile inertial sensors may be important kinematic indicators in a fall risk screening test to estimate the likelihood of falls among community-dwelling older people.

The effects of visual cues from optical stimulation devices on gait disturbance in patients with Parkinson's disease.

[Purpose] The purpose of this study was to identify the optimal visual cues for gait disturbance in patients with Parkinson's disease based on the luminous duration and the individual patient preferences for a wearable visual cue device. [Participants and Methods] Twenty-four patients with Parkinson's disease walked while wearing only a visual cue device in the control condition. They then walked while the device was set to two stimulus conditions: the luminous duration at 10% and 50% of the individual gait cycle. After walking under the two stimulus conditions, the patients were asked for their preferred visual cue condition. The walking results were compared between the two stimulus conditions and the control condition. Gait parameters were compared among the three conditions. The comparisons with preference, non-preference, and control conditions were also made for the same gait parameter. [Results] When compared to the control condition, walking with visual cues in the stimulus conditions reduced stride duration and increased cadence. The preference and non-preference conditions had shorter stride durations than the control condition. Furthermore, the preference condition also resulted in a faster gait speed than the non-preference condition. [Conclusion] This study suggests that a wearable visual cue device with the patient's preferred luminous duration may help manage gait disturbance in patients with Parkinson's disease.

Comparison of the effects of external focus of attention with metaphor and internal focus of attention on temporal changes in seating pressure during sitting motion in community-dwelling elderly people.

[Purpose] This study aimed to clarify the optimal method of attention focus in which temporal changes in the seating pressure can induce effective sitting motion in order to prevent osteoporotic vertebral fractures in the elderly. [Participants and Methods] This study included 101 community-dwelling elderly people. The participants were seated in a chair with a force plate under two conditions: external focus of attention with metaphor and internal focus of attention. We evaluated and analyzed the seating pressure by using the force plate and the sitting motion with a three-dimensional motion capture system. The unit time sitting pressure value and the trunk forward tilt angle were calculated and compared between the two conditions. [Results] The unit time sitting pressure value was significantly smaller in the external condition than the internal condition. The trunk forward tilt angle was significantly greater in the internal condition than the external condition. [Conclusion] This study demonstrated that external focus of attention with metaphor can induce a sitting motion with a slower temporal change in sitting pressure than the internal focus of attention. We concluded that external focus of attention with metaphor may be an effective instruction to prevent osteoporotic vertebral fractures in the elderly.

Modeling the effect of social interdependence in interprofessional collaborative learning.

Interprofessional education (IPE) often uses collaborative learning for better teamwork among multiple professions. Its theoretical background is social interdependence theory (SIT), and positive interdependence is key for successful collaborative learning. As there is little theoretical knowledge on how to optimize the social interdependence in IPE, educators often struggle to develop an effective program. Therefore, a more specific explanation of the relationship between social interdependence and interprofessional readiness might make IPE more effective. We aimed to elucidate how students' social interdependence in collaborative learning relates to interprofessional readiness. Health profession students (n = 259) undertaking a collaborative IPE program were asked to complete two validated questionnaires: Readiness for Interprofessional Learning Scale and Social Interdependence Scale in Collaborative Learning. A structural equation analysis provided a good fit for the data. Awareness of objectives positively predicted interprofessional collaboration and identity, whereas specific roles as health professionals negatively predicted interprofessional roles and identity. As the current healthcare system is highly specialized, there is a dilemma that the more specific a problem is, the clearer it is which profession is responsible for solving it. Hence, strengthening awareness collaboratively may overcome the dilemma. Also, it is necessary to reconstruct a curriculum based on the premise of interprofessional activities.

The ß-Secretase BACE1 in Alzheimer's Disease.

BACE1 (beta-site amyloid precursor protein cleaving enzyme 1) was initially cloned and characterized in 1999. It is required for the generation of all monomeric forms of amyloid-ß (Aß), including Aß42, which aggregates into bioactive conformational species and likely initiates toxicity in Alzheimer's disease (AD). BACE1 concentrations and rates of activity are increased in AD brains and body fluids, thereby supporting the hypothesis that BACE1 plays a critical role in AD pathophysiology. Therefore, BACE1 is a prime drug target for slowing down Aß production in early AD. Besides the amyloidogenic pathway, BACE1 has other substrates that may be important for synaptic plasticity and synaptic homeostasis. Indeed, germline and adult conditional BACE1 knockout mice display complex neurological phenotypes. Despite BACE1 inhibitor clinical trials conducted so far being discontinued for futility or safety reasons, BACE1 remains a well-validated therapeutic target for AD. A safe and efficacious compound with high substrate selectivity as well as a more accurate dose regimen, patient population, and disease stage may yet be found. Further research should focus on the role of Aß and BACE1 in physiological processes and key pathophysiological mechanisms of AD. The functions of BACE1 and the homologue BACE2, as well as the biology of Aß in neurons and glia, deserve further investigation. Cellular and molecular studies of BACE1 and BACE2 knockout mice coupled with biomarker-based human research will help elucidate the biological functions of these important enzymes and identify their substrates and downstream effects. Such studies will have critical implications for BACE1 inhibition as a therapeutic approach for AD.

Measuring social interdependence in collaborative learning: instrument development and validation.

BACKGROUND: In health professions education, several collaborative learning approaches have been used. As collaborative learning has a theoretical background of social interdependence theory, a theory informed and valid instrument to measure social interdependence is required to evaluate and compare several learning approaches. The aim of this study was to develop an instrument (the SOcial interdependence in Collaborative learning Scale; SOCS) to measure students' perceived social interdependence in collaborative learning and validate it. METHODS: We conducted a modified Delphi procedure among stakeholders to develop the content validity of the instrument. To establish construct validity, we performed a confirmatory factor analysis, and we estimated reliability. RESULTS: Two rounds of Delphi were conducted to develop the instrument. Confirmatory factor analysis yielded a three-factor model with 15 items, which provided an excellent fit with CMIN/df = 1.838, GFI = 0.924, CFI = 0.951, RMSEA = 0.061, and PCLOSE = 0.121. Alpha-coefficients for all factors indicated high internal consistency of all the factors. CONCLUSION: This study describes the development and construct validation of the SOCS for measuring social interdependence in collaborative learning. This instrument will provide teachers and schools with feedback about their classroom environment.

Effects of sudden unexpected mechanical perturbation training aimed at the primary prevention of inversion ankle sprain on reactiveness of ankle movement and cortical activity in normal young adults.

[Purpose] To determine the effects of sudden unexpected mechanical perturbation training aimed at the primary prevention of inversion ankle sprain on the reactiveness of ankle eversion movement and cortical activity. [Participants and Methods] Sixty healthy participants were randomly allocated equally into 1) the sudden unexpected mechanical perturbation training group, 2) self-paced training group, or 3) control group. The first two groups performed each course of training 3 days per week for 4 weeks. During pre-training and post-training, the latency to peak amplitude on the surface electromyography of the peroneus longus and the time to reposition the plate back to its initial position under the right foot after sudden unexpected mechanical perturbation were measured. Functional near-infrared spectroscopy was used to measure the changes in the concentration of oxygenated hemoglobin. [Results] The latency to peak amplitude was significantly shorter in group 1 than in group 2; time to reposition the plate was the shortest among the 3 groups during post-training. The changes in the concentration of oxygenated hemoglobin were significantly increased in the supplementary motor and pre-motor areas during post-training than during pre-training in group 1. [Conclusion] Sudden unexpected mechanical perturbation training may facilitate the primary prevention of inversion ankle sprain via the positive effects on the reactiveness of ankle eversion movement and cortical activity.

Enhancement of motor skill learning by a combination of ideal model-observation and self-observation.

[Purpose] In sports physical therapy, video of a patient's movement or of a skilled model's movement has been used as observational learning methods for injury prevention and movement modification. Positive effects of model video observation have been reported. This study aimed to clarify the effect on motor skill learning using a combination of model-observation and self-observation, which is thought to act as an enhanced method for active error detection by comparing model-observation and self-observation alone for acquisition of correct sports movement. [Subjects and Methods] Forty-five healthy females were randomly allocated into three groups comprising model- and self-observation, model-observation, and self-observation. The motor task performed was a half golf swing using an elastic club. Shoulder grip angle between both shoulder lines and the acromia grip strength were measured as an index of body rotation using a three-dimensional motion analyzer. Change in the shoulder grip angle in the three groups was analyzed at pre-, immediate delayed retention, and delayed retention tests. [Results] A significant difference in shoulder grip angle was observed among the three groups for the immediate delayed retention test. The combined model and self-observation group had a value closer to 90 degrees compared to the other two groups. [Conclusion] Observation combining model and self-observation exerted a positive effect on short-term motor skill learning.

The effect of different imitation models on theaccuracy and speed of imitation of movement.

[Purpose] The purpose of this study was to compare the accuracy, speed and subjective ease of imitation of movement using three different imitation models. [Subjects] Thirty-four right-handed healthy males participated in this study. [Methods] The imitation task chosen for this study was an asymmetric combined motion of the upper and lower limbs. Three kinds of imitation models were displayed on a screen as follows: a) third person perspective mirror imitation (3PM), b) third person perspective anatomical imitation (3PA), and c) first person perspective ipsilateral imitation (1PI). Subjects were instructed to imitate the movement shown on a screen as quickly and as accurately as possible. They executed four sets of the movement with each set consisting of one trial of each of the three imitation models. [Results] 3PM was the most accurate, and 1PI was the fastest in speed and subjective ease of imitation, compared with the other two imitation models. [Conclusion] These results suggest that 1PI and 3PM, which do not require mental rotation of the movement task as required by 3PA, should be considered more suitable imitation models for teaching healthy subjects how to move.

Characteristics of trunk control during crook-lying unilateral leg raising in different types of chronic low back pain patients.

STUDY DESIGN: Cross-sectional observational study. OBJECTIVE: To quantitatively clarify the characteristics of trunk control during unilateral leg-raising movement in different types of nonspecific chronic low back pain (NS-CLBP) patients who were identified by aggravation of symptoms during trunk movement. SUMMARY OF BACKGROUND DATA: Although there is a need to classify NS-CLBP patients for clinical decision making in physical therapy, the characteristics of trunk control during unilateral leg-raising movement in different types of NS-CLBP patients have not been quantitatively analyzed in previous studies by simultaneously measuring the lumbar spine movement, trunk muscle activity, and leg movement. METHODS: Thirty NS-CLBP patients, of whom 13 were aggravated by trunk flexion (flexion group) and 17 were aggravated by trunk extension (extension group), and 30 healthy controls performed crook-lying unilateral leg-raising movement on the painful side in patient group and the dominant leg in controls. During the unilateral leg-raising movement, pressure changes produced by the movement of the lumbar lordotic curve, measured by a custom-made recording device, were used as indices of the lumbar spine movement. Trunk muscle activities were recorded by surface electromyography and diagnostic ultrasonography. The pressure changes and trunk muscle activities were statistically compared among the 3 groups. RESULTS: At foot-off during unilateral leg-raising movement, the extension group demonstrated increase in pressure changes, whereas the flexion group and controls demonstrated decrease in pressure changes. Bilateral external obliques muscle activities in the extension group were significantly larger than those in the flexion group and controls (P < 0.05). CONCLUSION: This study demonstrated that the characteristics of trunk control during unilateral leg-raising movement were different depending on the types of NS-CLBP patients. These results indicate that patients with NS-CLBP might select compensatory trunk control strategies subconsciously to prevent the manifestation of LBP. These results also suggest the importance of the different characteristics of trunk control during active limb movement in the clinical reasoning process for the management of different types of NS-CLBP patients. LEVEL OF EVIDENCE: N/A.

Analysis of pelvic movement in the elderly during walking using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope.

The incidence of falls in the elderly is increasing with the aging of society and is becoming a major public health issue. From the viewpoint of prevention of falls, it is important to evaluate the stability of the gait in the elderly people. The pelvic movement, which is a critical factor for walking stability, was analyzed using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope. The subjects were 95 elderly people over 60 years of age. The criteria for instability were open-eye standing on one leg for 15s or less, and 11s or more on 3m timed up and go test. Forty subjects who did not meet both of these criteria comprised the stable group, and the remaining 55 subjects comprised the unstable group. Pelvic movement during walking was compared between the two groups. The angle, angular velocity, and acceleration were analyzed based on the wave shape derived from the device worn around the second sacral. The results indicated that pelvic movement was lower in all three directions in the unstable group compared to the stable group, and the changes in the pelvic movement during walking in unstable elderly people were also reduced. This report is the first to evaluate pelvic movement by both a triaxial accelerometer and a triaxial gyroscope simultaneously. The characteristics of pelvic movement during walking can be applied in screening to identify elderly people with instability, which is the main risk factor associated with falls.

Synthesis and pharmacological profile of serofendic acids A and B.

We present efficient syntheses of serofendic acids A and B (SA-A and SA-B), novel neuroprotective substances isolated from fetal calf serum. Biological and pharmacological evaluation showed that SA-A and SA-B have potent protective action against glutamate-induced neurotoxicity, but do not interact directly with glutamate receptors. A pharmacokinetic study showed that they have good oral bioavailability in rats. The results indicate that SA-A and SA-B are potential lead compounds for candidate drugs to treat various neurological disorders.

Characteristic Immune Response in Peyer's Patch Cells Induced by Oral Administration of Bifidobacterium Components.

We demonstrate immunomodulatory effects, especially those involving murine intestinal IgA secretion, in Peyer's patch cells following oral administration of Bifidobacterium immunomodulator (BIM) derived from sonicated B. pseudocatenulatum 7041. BALB/c mice were administered BIM orally for 7 consecutive days. The PP cells demonstrated upregulated secretion of total IgA including BIM-specific IgA following BIM administration. In observing the response of PP cells co-cultured with BIM, we found enhanced secretion of interferon-gamma (IFN-gamma) and interleukin (IL)-6 in the CD4(+) T cells. In contrast, IL-12 secretion by Thy1.2(-) PP cells was enhanced, but secretion of IFN-gamma, IL-5, and IL-6 was not significantly affected. Furthermore, the population of CD4(+) CD45RB(high) T cells in PP increased following oral administration of BIM. These data suggest that CD4(+) T cells were affected by BIM administration. Overall, the results show that oral administration of BIM induced CD4(+) PP cells to change their expression of cell surface antigen and cytokine production.

Property analysis of ectopic calcification in the carpal tunnel identification of apatite crystals: a case report.

INTRODUCTION: A 64-year-old woman presented with symptoms of subacute exacerbation of a year-long carpal tunnel syndrome that was caused by a large calcified mass in the tunnel. CONCLUSION: The resected mass consisted of very tiny rods, and x-ray diffraction analysis, as well as the component analysis using energy dispersive x-ray microanalysis, revealed the mass to be most compatible with apatite. The back-scattered electron images suggested that precipitation might be a mechanism for development of the calcified mass.

Dietary fructooligosaccharides induce immunoregulation of intestinal IgA secretion by murine Peyer's patch cells.

Probiotic supplements induce immunological responses in the host, and dietary fructooligosaccharides (FOS) stimulate the growth of selected intestinal microflora. In this study we investigated the immunological influences of orally administrated FOS. BALB/c mice were orally administered 0-7.5% FOS for 6 weeks, and the intestinal mucosal immune responses were measured. In the 2.5%-FOS group, fecal IgA was significantly increased. IgA secretion by Peyer's patch (PP) cells was upregulated in a dose-dependent way in response to FOS and CD4+ T cells from PP showed a dose-dependent increase in production of interferon-gamma and interleukin (IL) 10, and a high response in production of IL-5 and IL-6. In contrast, FOS suppressed serum IgG1. Our findings suggest that FOS supplementation changes the intestinal environment of microflora, and leads to upregulation of IgA secretion in CD4+ PP cells in intestinal mucosa, and to suppression of the systemic immune response to type 2 helper T (Th2) dominant.

Discovery of novel neuronal voltage-dependent calcium channel blockers based on emopamil left hand as a bioactive template.

A series of novel neuronal voltage-dependent calcium channel (VDCC) blockers, with inhibitory activity at low micromolar and moderate solubility in water, was discovered by constructing and screening a focused library based on emopamil (1) left hand (ELH) as a bioactive template.

Vein grafting with telescoping anastomoses for repair of a double-cut artery.

The rat femoral artery was cut in two places, and the telescoping anastomosis technique was used for all vascular repairs in combination with vein grafting, to determine whether the telescoping technique could safely be used more than three times for repair of an artery that has been injured at two places. One cut was repaired with vein grafting, and the other with either a telescoping anastomosis (the triple group) or with a second vein grafting (the quadruple group). The patency rate 3 weeks postoperatively was 86.4% for the triple group, and 90.5% for the quadruple group. Although tension of the repaired vessel was kept low by vein grafting, and deformities of the inserted vessel were carefully minimized, the patency rate was not 100%. It appears that a telescoping anastomosis should not be used more than three times on the same artery in combination with vein grafting.

Practical synthesis of chiral emopamil left hand as a bioactive motif.

An asymmetric synthesis of (2S)-2-(2-isopropyl)-5-hydroxy-2-phenylpentanenitrile (emopamil left hand, 2) has been completed by use of the MAD (methyl aluminum bis(4-methyl-2,6-di-tert-butylphenoxide)-induced rearrangement of a chiral epoxyalcohol as the key reaction. The stereochemistry of the chiral quaternary center was confirmed by transformation of 2 to (S)-noremopamil. This method requires minimal purification procedures and affords high chemical and optical yields. Acid-catalyzed isomerization of an allylaldehyde and retro-aldol type racemization at the quaternary carbon of a nitrile-alcohol were encountered.