Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance.

Introduction: A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance. Methods: A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge. Results: Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO. Discussion: For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.

A case of a novel hemoglobin variant, Hb A2-Karatsu, discovered following a falsely elevated HbA1c value.

The patient, a man in his thirties, presented to our hospital for a secondary examination after a 2020 medical check-up found a high hemoglobin A1c (HbA1c) level on high-performance liquid chromatography (HPLC). The HbA1c level determined by HPLC (HA-8180V, fast mode) was elevated at 6.8%, but a 75-g glucose tolerance test showed normal glucose tolerance. The glycated albumin level was within the reference range at 14.6%. The continuous glucose monitoring-derived mean blood glucose and the percentage of time in range were 99 mg/dL and 98%, respectively. The HbA1c levels determined by HPLC (G9, fast mode), enzymatic assay, and immunoassay were all 5.3%. An isoelectric focusing analysis showed an abnormal band on the anode side of HbA2, and a globin gene analysis detected a heterozygous mutation at codon 144 [AAG (Lys) → TAG (stop codon)] in the δ-chain. Since this mutation is a novel δ-chain hemoglobin variant, it was given the name 'Hb A2-Karatsu'.

The development of Ambulation Independence Measure: A new measurement tool to assess gait ability in acute stroke patients.

BACKGROUND: The assessment of gait function is important for stroke rehabilitation. Gait function of patients with stroke often depends on the type of orthosis. There are however few gait assessments that assess the type of orthosis. OBJECTIVE: The purpose of this study was to investigate the reliability and validity of our newly developed Ambulation Independence Measure (AIM), which assesses the gait function, type of orthoses and physical assistance, for acute stroke patients. METHODS: A total of 73 acute stroke patients participated in this prospective study. The AIM discriminates 7 levels of gait ability on the basis of the amount of physical assistance required and orthoses that are used during walking. Interrater reliability, concurrent validity with the Functional Ambulation Category (FAC) and predictive validity were examined. RESULTS: The weighted kappas of AIM at the start of gait training (baseline) and discharge were 0.990 and 0.978, respectively. The AIM scores were significantly correlated with the FAC scores at both baseline (r = 0.808) and discharge (r = 0.934). Multiple regression analyses showed that the AIM at baseline was a stronger predictor of the FAC at discharge (R2 = 0.80). CONCLUSIONS: The AIM has excellent reliability, concurrent validity, predictive validity, and good responsiveness in acute stroke patients.

Effect of Cross-Linking on the Mechanical and Thermal Properties of Poly(amidoamine) Dendrimer/Poly(vinyl alcohol) Hybrid Membranes for CO2 Separation.

Poly(amidoamine) (PAMAM) dendrimers were incorporated into cross-linked poly(vinyl alcohol) (PVA) matrix to improve carbon dioxide (CO2) separation performance at elevated pressures. In our previous studies, PAMAM/PVA hybrid membranes showed high CO2 separation properties from CO2/H2 mixed gases. In this study, three types of organic Ti metal compounds were selected as PVA cross-linkers that were used to prepare PAMAM/cross-linked PVA hybrid membranes. Characterization of the PAMAM/cross-linked PVA hybrid membranes was conducted using nanoindentation and thermogravimetric analyses. The effects of the cross-linker and CO2 partial pressure in the feed gas on CO2 separation performance were discussed. H2O and CO2 sorption of the PAMAM/PVA hybrid membranes were investigated to explain the obtained CO2 separation efficiencies.