Risk of Transient Tachypnea of the Newborn following Elective Cesarean Section Increases at a Gestational Age of 37 Weeks Compared to That at ≥ 38 Weeks Despite the Exclusion of Pre-Existing Risk Factors for Neonatal Respiratory Disorders.

Background: Elective cesarean sections (ECSs) for early-term pregnancies at 37 weeks of gestational age (GA) aim to reduce the risk of emergency cesarean sections due to the onset of labor or rupture of membranes. However, resultant increases in neonatal respiratory disorders, including transient tachypnea of the newborn (TTN) have been observed. However, few studies have elucidated the associated risk factors. Consequently, we aimed to determine whether differences existed in the clinical outcomes between neonates delivered via ECS at 37 weeks and those delivered at ≥ 38 weeks of GA. Methods: A retrospective analysis was conducted on 259 neonates born via ECS at Tottori University Hospital, between January 2013 and December 2019, with birthweights ≥ 2500 g and GAs > 37 weeks. The neonates were categorized into two cohorts: births at 37 and at ≥ 38 weeks of GA (37-week and 38-week cohorts). The principal clinical outcomes included the appearance, pulse, grimace, activity, and respiration (Apgar) scores, need for positive-pressure ventilation, incidence of TTN, and length of hospital stay. Results: No statistically significant differences were observed in the indications for ECS, sex, or birthweight between the two cohorts. The 37-week cohort exhibited a lower 1-min Apgar score than did the 38-week cohort, with no statistically significant differences between the two cohorts, at 5 min. Statistically significant differences were not observed in the need for positive-pressure ventilation during initial resuscitation or length of hospital stay for patients with TTN between the two cohorts. Notably, the 37-week cohort exhibited a significantly higher incidence of TTN than did the 38-week cohort. Conclusion: ECSs at 37 weeks of GA exhibited an increased risk of TTN than ECSs at ≥ 38 weeks of GA. Strategic neonatal care and adequate preparation can mitigate this risk without affecting the length of hospital stay.

Smoothness of gait in healthy older females and patients with postoperative proximal femur fracture.

[Purpose] This study aimed to investigate the usefulness of a quality index in gait for proximal femur fractures. [Participants and Methods] In this study, 20 females with postoperative proximal femur fracture in the preparation phase for discharge (femur fracture group) aged ≥60 years (63.0 ± 3.0 years) and 20 healthy older females (healthy group) participated (75.7 ± 7.7 years) (n=40). Measurements were conducted at comfortable and maximal gait speeds. Power spectrum entropy (PSE), harmonic ratio (HR), and modified HR (mHR), which are smoothness indices, were calculated from the measured data in each of the three axial directions and compared. [Results] The healthy and femur fracture groups showed significant differences in the PSE, HR, and mHR for comfortable and maximal gait speed in the lateral and vertical directions. Furthermore, all directions between the HR and mHR in the femur fracture group had significant differences. [Conclusion] The usefulness of the PSE, HR, and mHR as quality evaluation indices of gait was demonstrated in patients with postoperative femur fractures after unilateral disability.

Smoothness Evaluation Indices during Sit-to-Stand-to-Sit Motions in Healthy Older Females and after Hip Fracture Using an Accelerometer: A Pilot Study.

BACKGROUND: Studies that quantify the quality of sit-to-stand-to-sit (STS) motions, particularly in terms of smoothness, are limited. Thus, this study aimed to investigate the possibility and usefulness of quality evaluation during STS motions. METHODS: This cross-sectional study enrolled 36 females aged >60 years, including 18 females each in the healthy and hip fracture groups. Measurements were performed at two different speeds: five STS as fast as possible (STSF) and two seconds for each motion (STS2s). Indices of smoothness, including harmonic ratio (HR) and power spectrum entropy (PSE), were calculated and compared from the measured data in each of the three axial directions. RESULTS: HR in the vertical direction was significantly higher in the healthy group (STSF: 3.65 ± 1.74, STS2s: 3.42 ± 1.54) than in the hip fracture group (STSF: 2.67 ± 1.01, STS2s: 2.58 ± 0.83) for STSF and STS2s. Furthermore, PSE for all directions and triaxial composites were significantly lower for STS2s (the healthy group (mediolateral (ML): 7.63 ± 0.31, vertical (VT): 7.46 ± 0.22, anterior-posterior (AP): 7.47 ± 0.15, triaxial: 7.45 ± 0.25), the hip fracture group (ML: 7.82 ± 0.16, VT: 7.63 ± 0.16, AP: 7.61 ± 0.17, triaxial: 7.66 ± 0.17)). CONCLUSIONS: This study suggests the usefulness of HR and PSE as quality evaluations for STS motions.

Temporary venovenous extracorporeal membrane oxygenation after cardiopulmonary bypass in minimally invasive cardiac surgery via right minithoracotomy.

Objectives: In minimally invasive cardiac surgery, it can be difficult at times to maintain adequate oxygenation with single-lung ventilation after weaning from cardiopulmonary bypass (CPB), and intermittent double-lung ventilation is required during hemostasis. Venovenous extracorporeal membrane oxygenation (VV-ECMO) after weaning from CPB eliminates the necessity of overinflation of the left lung and intermittent double-lung ventilation and enables secure and fast hemostasis. We investigated the effectiveness and safety of temporary VV-ECMO in MICS. Methods: Between May 2018 and March 2021, 149 patients underwent temporary VV-ECMO during minimally invasive cardiac surgery in our institutions. After weaning from CPB, the arterial circuit was reconnected to the right internal jugular venous cannula, the femoral venous cannula was pulled down by 20 cm, and VV-ECMO was established using the CPB machine and cannulas. After starting VV-ECMO, we administered protamine and performed hemostasis. Operative data and outcomes were retrospectively reviewed. Results: The mean VV-ECMO time and flow were 26 ± 13 minutes and 2.38 ± 0.40 L/m2, respectively. There was no thrombus in the CPB circuit, including the oxygenator. The trans-oxygenator pressure gradient index at the end of VV-ECMO significantly correlated with that at the start of VV-ECMO (r = 0.88; 95% CI, 0.79-0.94; P = .01). The 30-day mortality rate was 2.0%. The incidences of unilateral pulmonary edema, prolonged ventilation, and re-exploration for bleeding were 2.7%, 5.4%, and 2.0%, respectively. Conclusions: Temporary VV-ECMO is safe and useful to maintain single-lung ventilation without overinflation after weaning from CPB for secure and fast hemostasis in minimally invasive cardiac surgery. No thrombotic event was found during temporary VV-ECMO without heparinization.

Mid-term outcomes of non-resectional chordal foldoplasty for degenerative mitral regurgitation.

OBJECTIVES: We aimed to evaluate the mid-term clinical and echocardiographic outcomes of chordal foldoplasty performed for non-resectional mitral valve repair in degenerative mitral valve disease with a large posterior leaflet. METHODS: We reviewed 82 patients undergoing non-resectional mitral valve repair via chordal foldoplasty between October 2013 and June 2021. We analysed operative outcomes, mid-term survival rate, freedom from reoperation and freedom from recurrent moderate or severe mitral regurgitation (MR). RESULTS: The mean age of patients was 57.2 ± 12.4 years; 61 patients (74%) had posterior leaflet prolapse, 21 patients (26%) had bileaflet prolapse and all of them had at least 1 tall posterior leaflet scallop. Minimally invasive approach with a right mini-thoracotomy was used in 73 patients (89%). The operative mortality was zero. There was no conversion to mitral valve replacement and postoperative echocardiography revealed no more than mild residual regurgitation or systolic anterior motion. Five-year survival rate, freedom from mitral reoperation and freedom from recurrent moderate/severe MR were 93.9%, 97.4% and 94.5%, respectively. CONCLUSIONS: Non-resectional chordal foldoplasty is a simple and effective repair technique for select degenerative MR cases with a tall posterior leaflet.

Endoscopically assisted selective antegrade cardioplegia in minimally invasive aortic valve replacement for patients with aortic insufficiency.

Objective: In minimally invasive aortic valve replacement via a right minithoracotomy for patients with significant aortic insufficiency, optimal cardioplegia delivery procedures remain controversial. This study aimed to describe and evaluate endoscopically assisted selective cardioplegia delivery in minimally invasive aortic valve replacement for aortic insufficiency. Methods: Between September 2015 and February 2022, 104 patients (mean age, 66.0 ± 14.3 years) with moderate or greater aortic insufficiency underwent endoscopically assisted minimally invasive aortic valve replacement at our institutions. For myocardial protection, potassium chloride and landiolol were systemically administered before aortic crossclamping, and cold crystalloid cardioplegia was delivered selectively to the coronary arteries using step-by-step endoscopic procedures. The early clinical outcomes were also evaluated. Results: Eighty-four patients (80.7%) had severe aortic insufficiency, and 13 patients (12.5%) had aortic stenosis and moderate or greater aortic insufficiency. A regular prosthesis was used in 97 cases (93.3%), and a sutureless prosthesis was used in 7 cases (6.7%). The mean operative, cardiopulmonary bypass, and aortic crossclamping times were 169.3 ± 36.5, 102.4 ± 25.4, and 72.5 ± 21.8 minutes, respectively. No patients underwent a conversion to full sternotomy or required mechanical circulatory support during or after surgery. No operative deaths or perioperative myocardial infarctions occurred. The median intensive care unit and hospital stays were 1 and 5 days, respectively. Conclusions: Endoscopically assisted selective antegrade cardioplegia delivery is safe and feasible for treating minimally invasive aortic valve replacement in patients with significant aortic insufficiency.

Intractable arteriovenous access-related pain relieved after a single, pain-free hemodialysis session under selective block of the sensory nerves in the upper limb: A psychosocial factorial case.

Intractable arteriovenous access (AVA)-related pain can not only lead to abandonment of a well-functioning AVA, but can also cause hemodialysis (HD) patients to be unwilling to accept, interrupt, or withdraw from HD. Such pain primarily derives from nociceptive and neuropathic factors caused by mechanical stimulation of needle cannulation; however, this might be related to psychosocial factors making it difficult for patients to accept their dependency on HD. Furthermore, the pain can be complicated by the interaction of biological and psychosocial factors, which hampers appropriate pain management and treatment. However, there have been few investigations pertaining to this matter. Herein, we describe the case of an HD patient who experienced chronic refractory AVA-related pain during a 32-month period of HD sessions, which occasionally caused treatment interruption. After clinical inquiry, physical evaluation, and ultrasonographic assessment of the blood circulation and cutaneous nerves in the ipsilateral upper limb to the radiocephalic arteriovenous fistula in the anatomical snuffbox, we diagnosed the patient with primarily psychosocially driven pain in consultation with an experienced pain clinician. A single, pain-free HD session under ultrasound-guided sensory nerve blocks in the upper limb markedly relieved her pain, followed by HD sessions with subtle but acceptable pain. This report provides insights into the mechanism underlying the vicious cycle of AVA-related pain, including the psychosocial aspects that might trigger such pain, as well as into the importance of treating such pain to improve the patient's quality of life, and underscores the need for cooperation of experts engaged in HD and pain management.

Dystonia-like Movement Disorders Ameliorated by Shear Force and Pressure Stimulation after Small Infarction in the Left Posterolateral Thalamus.

Focal dystonia (FD) can develop after thalamic lesions. Abnormal somatic sensations were argued to be responsible for FD. Our patient experienced FD-like movement disorders, agraphesthesia, and a reduced sense of shear force on the skin and pressure to deep tissues of the right upper limb following a small infarction in the left posterolateral thalamus. FD-like symptoms improved while the skin was being pulled or the deep tissue was being pushed in a manner proportional to the strength of muscle contractions. Therefore, the lack of these sensations was suggested to be related to FD-like symptoms.

Influence of fat infiltration, tear size, and post-operative tendon integrity on muscle contractility of repaired supraspinatus muscle.

BACKGROUND: The purpose of this study was to evaluate the effect of fat infiltration, tear size, and post-operative tendon integrity, on post-operative contractility. METHODS: Thirty-five patients who underwent rotator cuff repair were included. The fat infiltration, tear size, and post-operative tendon integrity were evaluated by Goutallier stage, Cofield classification, and Sugaya classification, respectively. The muscle elasticity at rest and at contraction was assessed by real-time tissue elastography pre- and one-year post-operatively. We defined the difference in elasticity between at rest and at contraction as the activity value which reflects muscle contractility. RESULTS: The activity value in patients with Sugaya Type I tended to increase regardless of Cofield classification, whereas those with Sugaya Type III and IV tended to decrease. While the activity value in the patients classified as stage 1 and Type I tended to increase, patients classified as stage 2 showed decreased or constant in contractility even in those subjects classified as Type I. Stepwise multiple regression analysis showed both pre- (p = 0.004, r = -0.47) and post-operative activity values (p = 0.022, r = -0.39) to be significantly correlated only with the Goutallier stage. CONCLUSION: Multiple regression analysis indicated only the Goutallier stage was a significant independent factor for contractility of the supraspinatus muscle. Supraspinatus muscle contractility in patients classified as Types III and IV based on the Sugaya classification tended to decrease post-operatively, while patients whose contractility increased post-operatively were characterized by having a Type I tendon integrity.

Elastographic Region of Interest Determination for Muscle with Fat Infiltration.

PURPOSE: Ultrasound elastography has been used to evaluate the skeletal muscle stiffness as a biomarker for sarcopenia assessment. However, there is no consensus with respect to the size and location of the region of interest in assessing such fat infiltrated muscle. The objective of this study was to determine which cross-sectional area should be measured in torn disuse muscle with fat infiltration to accurately measure muscle activity using real-time tissue elastography (RTE). METHODS: Twenty-seven patients, whose rotator cuff muscle with torn tendon was successfully repaired, were followed by programmed rehabilitation. RTE measurements of the supraspinatus muscle were obtained during muscle contraction before and one-year after surgery so that the activity value was defined as the difference between elastography measurements at rest and elastography measurements during contraction. Given that the patients with successfully repaired and completed rehabilitation showed an increased activity value, the sensitivity for three regions of interest; posterior portion of the anterior-middle subregion (AM-p), anterior region (AR), and whole cross-sectional area of the supraspinatus (whole) were compared with the number of patients showing an increase in activity values as sensitivity analysis. RESULTS: The sensitivity showing an increase in activity values was 74.1% for the AM-p area, 70.4% for the AR area, and 81.5% for the whole area. Intraclass correlation coefficient1,3 was 0.87-0.97 for the AM-p area, 0.88-0.98 for the AR area and 0.92-0.99 for the whole area. CONCLUSION: The whole cross-sectional area is suitable to measure muscle activity in muscle with fat infiltration. The results in this study will provide some beneficial information when ultrasound elastography is used for the assessment of sarcopenia muscle with fat infiltration.

Motor Function and Activities of Daily Living Recovery after Cardiogenic Internal Carotid Artery Infarction: A Retrospective Cohort study.

OBJECTIVES: this study determines recovery in physical activity and activities of daily living in the early stages after cardiogenic internal carotid artery infarction. MATERIALS AND METHODS: this retrospective comfort study compares assessment data for 334 patients: 150 patients had atherosclerotic infarction (67 internal carotid artery, 87 middle cerebral artery) and 180 had cardiogenic infarction (32 internal carotid artery infarction, 148 middle cerebral artery). We used Brunnstrom recovery score, posture assessment scale for stroke, and functional independence measure. RESULTS: on initial assessment, median Brunnstrom recovery for the cardiogenic internal carotid artery infarction group was I-II in the upper limb, I in the finger, I-II in the lower limb, and IV or higher in all other groups. The median Postural Assessment Scale for Stroke score for the cardiogenic internal carotid artery infarction group was 0; all other groups scored 14 or higher. The median Functional Independence Measure for the cardiogenic internal carotid artery infarction group was 18 (maximum of 100) and the median score for other infarct groups was 25-50 (maximum 126), with P < .01. After a month, final assessment results for the cardiogenic internal carotid artery infarction group were much lower than for the other groups. Only both internal carotid artery infarctions were compared. Atherosclerotic infarctions showed recovery across assessments, except understanding, onset, and memory (P < .01), and cardiogenic infarctions did not change from the initial assessment in all criteria assessed. CONCLUSIONS: adapting cardiogenic internal carotid artery infarction as a stroke recovery model is difficult.

Amyloid A amyloidosis in a patient with Caplan's syndrome, with special reference to genetic predisposition.

Secondary amyloid A (AA) amyloidosis, which is a disorder of protein conformation and metabolism, is an important serious complication of inflammatory diseases, especially rheumatoid arthritis (RA). AA amyloidosis develops when AA fibrils, which are derived from the acute-phase reactant, serum amyloid AA (SAA) protein, in the circulation, are deposited in organs and cause systemic organ dysfunction. Caplan's syndrome, or rheumatoid pneumoconiosis, is a rare type of lung disease in which individuals suffering from RA develop lung nodules that are associated with occupational exposure to silica and coal dust. Confirmation of diagnosing as Caplan's syndrome requires the patient's occupational history, imaging studies, and serology. A 72-year-old male, working as a tunnel construction worker for 38 years, with RA who had both chronic cardiac and renal dysfunction was referred to our hospital. He received a diagnosis of pneumoconiosis about 20 years ago, after which he was also diagnosed with RA. So far we performed medical English literature searches on the combination of Caplan's syndrome with AA amyloidosis; there were no articles in relation to such association. Although RA is one of the most common underlying diseases that occur with AA amyloidosis, our report here is the first description of a case of Caplan's syndrome associated with AA amyloidosis. In this report, we provide details about this rare disease occurring with AA amyloidosis and discuss on the possible pathogenesis of AA amyloidosis from a genetic point of aetiological view.

Influence of kinesiophobia with pregnancy-related lumbopelvic pain at late pregnancy on postpartum depressive symptoms.

OBJECTIVE: To investigate whether kinesiophobia with pregnancy-related lumbopelvic pain at late pregnancy influenced depressive symptoms at 1 month after delivery. METHOD: Final participants were 43 pregnant women who experienced pregnancy-related lumbopelvic pain at late pregnancy and completed self-reported questionnaires at late pregnancy and 1 month after delivery. The Tampa Scale for Kinesiophobia was used to evaluate kinesiophobia, and depressive symptoms were assessed using the Self-Rating Depression Scale. We divided participants into two groups (depression and no-depression) using the score of the Self-Rating Depression Scale at 1 month after delivery. Univariate analysis and multiple logistic regression analysis identified kinesiophobia at late pregnancy as an independent predictor of depression at 1 month after delivery. RESULTS: In univariate analysis, kinesiophobia at late pregnancy was significantly higher in the depression group than in the no-depression group (P= .033). In multiple logistic regression analysis, kinesiophobia at late pregnancy were significantly associated with depression at 1 month after delivery even after adjusting for confounding factors (Odds Ratio, 1.25; 95% Confidence Interval, 1.03-1.52). CONCLUSION: Results found that kinesiophobia at late pregnancy negatively influenced depressive symptoms at 1 month after delivery, suggesting that approaches to treat kinesiophobia at late pregnancymight reduce the risk of onset of postpartum depressive symptoms.

Eating and Grooming Abilities Predict Outcomes in Patients with Early Middle Cerebral Infarction: A Retrospective Cohort Study.

Patients with cerebrovascular disorders are often forced to rest, with early prognosis made by bedside examination. However, overloading, for example, talking for a long time, may worsen the condition. We hypothesized that activities of daily living (ADL) from the Functional Independence Measure (FIM) that were actually performed regularly are useful to predict prognosis. The present study was aimed at determining the predictive items related to predicting prognosis from the status of early motor paralysis and ADL in patients with acute middle cerebral artery (MCA) infarction. We examined 367 patients with MCA infarction for Brunnstrom recovery stage (BRS) and FIM within 4 days of admission and modified the Rankin Scale before onset and just before discharge. Logistic regression analysis was used to compare two groups of patients based on their postdischarge destination (Home/another hospital or facility). The logistic regression analysis showed the following: BRS Hand: odds ratio (OR) 1.641 (95% CI 1.642 (1.336-2.017), p < 0.001); FIM Grooming: OR 1.279 (95% CI 1.220-1.807, p < 0.001); and FIM Eating: OR 1.280 (95% CI 1.102-1.488, p < 0.001). On the other hand, the ROC analysis showed the ROC area for Eating to be 0.830 (95% CI 0.787-0.874), for Grooming to be 0.81 (95% CI 0.765-0.865), and for BRS Hand to be 0.805 (95% CI 0.760-0.851). The BRS Hand and FIM Eating and Grooming domains were identified as predictive factors using the following cutoff points: BRS Hand stage V and FIM scores of 5 for Eating and 4 for Grooming. The cutoff points for the BRS Hand and FIM Eating revealed that, at a minimum, such patients can use the nonaffected hand. The presence of cognitive dysfunction or dysphagia affects these domains. Therefore, these results suggested that Eating and Grooming are appropriate as evaluation items.

Capsular attachment of the subregions of rotator cuff muscles.

PURPOSE: This study aimed to morphologically and histologically investigate the relationship between deep subregions of the rotator cuff muscle and shoulder joint capsule as well as the relationship between the rotator cuff tendon or capsule and bony insertion. METHODS: We examined 13 shoulders of embalmed cadavers and measured the capsular attachments and footprints macroscopically. We also histologically examined the fibres in three shoulders. RESULTS: Loose attachment, which was less tight with spaced connective tissue, and firm attachment, which was tight with dense connective tissue, were found under the surface of the supraspinatus and infraspinatus. The anterior-deep and posterior-deep subregions of the supraspinatus and the middle partition and inferior partition of the infraspinatus formed firm attachments to the capsule. The mean areas of firm attachment for the anterior-deep subregion, posterior-deep subregion and middle partition were 118.8 mm2, 267.8 mm2 and 399.3 mm2, respectively, while the area of the inferior partition was small. The transverse fibres were located just lateral to the medial edge of the firm attachment area. The thick capsule had a substantial footprint. Both tendon fibres and the capsule inserted into the superior and middle facets through the attachment fibrocartilage. CONCLUSIONS: The posterior-deep subregion of the supraspinatus and middle partition of the infraspinatus evenly occupied the capsular attachment area. The transverse fibres were located just lateral to the medial edge of the firm attachment area, and the thick capsule had a substantial footprint. Both tendon fibres and the capsule inserted into the superior and middle facets through the attachment fibrocartilage.

Sexual Norms for Lesbian and Bisexual Women in a Culture Where Lesbianism Is Not Acceptable Enough: The Japanese Survey About Sexual Behaviors, STIs Preventive Behaviors, and the Value of Sexual Relations.

This study aimed to identify key factors preventing STIs among women who have sex with women in Japan. This description is based on survey and open-ended responses from participants. The questionnaire contained participants' background, sexual behavior, STI prevention behavior, experience and knowledge of STIs, and the value of sex with women. 104 responded, and 92 (88.5 %) reported having sexual experience with women. A variety of sexual behaviors were reported. Regarding STIs, 14.4% of participants had an STI in past. Almost half of the participants cited measures to prevent STIs included hygienic activities. Participants believed that sexual relations accompany partnership with females.

Contractile property measurement of the torn supraspinatus muscle using real-time tissue elastography.

HYPOTHESIS: In the restoration of shoulder abduction, decreased contractility of the torn rotator cuff muscle may be a cause of a poor result. The aim of this study was to investigate the relationship between the contractile property of the torn supraspinatus muscle measured by real-time tissue elastography and the Goutallier stage as modified by Fuchs et al. METHODS: The muscular hardness of the torn supraspinatus muscle was measured in 32 patients at rest and during isometric contraction with the shoulder abducted to 60° in the scapular plane. The muscular hardness was calculated as the strain ratio. Fatty degeneration was assessed according to the modified Goutallier stage. Because the activity value (defined as the difference between the strain ratio at rest and the strain ratio during isometric contraction) estimated the contractile property of the muscle, stepwise multiple regression analysis was used to compare the activity value with age, sex, side, time from injury onset to obtaining the measurements, and modified Goutallier stage. RESULTS: The mean activity value was 0.26 ± 0.16. Fatty degeneration of the supraspinatus muscle was grade 0 in 5 patients, grade 1 in 16, grade 2 in 10, and grade 3 in 1. The activity value was significantly correlated only with the modified Goutallier stage (r = -0.78, P < .001). CONCLUSION: The contractile property of the supraspinatus muscles decreased with an increase in the modified Goutallier stage. Real-time tissue elastography can measure the contractile property of the muscles before surgery and thus may be a predictor for the resulting restoration of lost muscle function.

Oligosynaptic inhibition mediated by group Ia afferents from flexor digitorum superficialis to wrist flexors in humans.

Effects of low-threshold afferents from the flexor digitorum superficialis (FDS) to the flexor carpi radialis (FCR), flexor carpi ulnaris (FCU) and extensor carpi ulnaris (ECU) motoneurons were examined using a post-stimulus time-histogram (PSTH) and electromyogram-averaging (EMG-A) methods in seven healthy human subjects. Electrical conditioning stimulation to the median nerve branch innervating FDS with the intensity immediately below the motor threshold was delivered. In the PSTH study, the stimulation produced a trough (inhibition) in 19/44 (43%) of FCR and 17/41 (41%) of FCU motor units. Remaining motor units received no facilitatory and inhibitory effects. The central latency of the inhibition was 1.1 ± 0.6 ms (mean ± SD) and 0.6 ± 0.4 ms longer than that of the homonymous monosynaptic Ia facilitation of FCR and FCU, respectively. In the EMG-A study, the stimulation produced a trough (inhibition) in EMG-A of FCR and FCU in all the seven subjects. Amount of the inhibition was 14.5 ± 3.8% (FCR) and 17.9 ± 2.5% (FCU). Since the inhibition diminished after withdrawal of tonic vibration stimuli to the FDS muscle belly, group Ia afferents should be responsible for the inhibition. The stimulation did not produce facilitatory or inhibitory effect on ECU motoneurons in both the PSTH and EMG-A studies. These findings suggest that group Ia afferents from FDS inhibit excitability of motoneurons supplying FCR and FCU through an oligo (di- or tri-) synaptic path in the spinal cord. The reflex arcs would function to prevent wrist flexion during hand grasping movements.