Application of a wearable switch to perform a mouse left click for a child with mix type of cerebral palsy: a single case study.

Purpose: Children with cerebral palsy may face difficulties using handheld pointing devices, due to involuntary muscle movements. This study aimed at describing the idea of the new wearable sensor switch and assessing its feasibility as an access solution in a case of mixed-type cerebral palsy.Methods: The study participant was a 17-year-old male with mixed-type cerebral palsy characterized by chorea-athetotic movements and bilateral spasticity with gross motor function classification system level V. He exhibited sudden and irregular involuntary upper limb movements when sitting. Because spastic finger movements limited his ability to use a handheld mouse, he used a trackball near his neck as a pointing device (previous input method). The wearable switch system using a stretchable strain sensor was introduced; the sensor was attached to a groove worn on the dorsal regions of the right hand crossing the proximal interphalangeal and metacarpophalangeal joints of the middle finger (new input method). The switch turned on when the subject flexed his middle finger.Results: The user successfully turned the switch on and typed almost the same numbers of characters per trial compared with the previous input method. The speed of his head movements during typing reduced (p < .01), and his sitting posture was nearly upright during computer operation (p < .01). No involuntary movement, requiring physical assistance, was observed when using the wearable switch.Conclusion: The new switch system can be a new option for people with difficulty using standard handheld input devices due to paralysis and involuntary muscle movements.Implications for rehabilitationCerebral palsy is a major cause of motor dysfunction and spasticity and dyskinesia in the fingers and upper limbs may prevent children with cerebral palsy from using handheld input devices.Wearable devices may be useful for children with cerebral palsy who have limited access to handheld pointing devices.We developed a new wearable switch to control devices using a flexible stretchable sensor.The wearable switch contributed to the improvement of sitting posture and reduction of neck burden during the typing task at the speed equivalent to that using the previous method in a child with mixed type of cerebral palsy exhibiting choreoathetotic movements and bilateral spasticity.

Relationship between stature and tibial length for children with moderate-to-severe cerebral palsy.

OBJECTIVE: To derive the equation for estimating stature, based on tibial length, for children with moderate-to-severe cerebral palsy (CP) and lower limb joint contracture or scoliosis. METHODS: The participants (3-12-years-old) included 50 children with moderate-to-severe CP (mean age, 8.3±2.4 years) and 38 typically developed (TD) children (mean age, 7.5±2.6 years). Thirty-four (68%) of the children with CP had a gross motor function classification system level of V. Furthermore, 40 (80%) had definite lower limb joint contracture or scoliosis. The stature and the tibial length measurements of all participants were determined. Regression equations to estimate stature, based on tibial lengths, were determined for both TD children and children with CP. Moreover, regression equations defining the relationship between tibial length and age were compared between the two groups of children, using multiple regression analysis. RESULTS: The regression equations for estimating stature, based on tibial length, were stature=tibial length×3.25+34.45 [cm], R(2)=0.91 (TD children), and stature=tibial length×3.42+31.82 [cm], R(2)=0.81 (CP children). In children with CP, tibial lengths were significantly shorter than those in similarly aged TD children. CONCLUSION: The stature of children with moderate-to-severe CP can be estimated from their tibial lengths, regardless of the presence of joint contracture or scoliosis. The tibial length may be a proxy for estimating stature during the growth assessment of children with moderate-to-severe CP.

[Reliability of the measurement of stature in subjects with severe motor and intellectual disabilities].

OBJECTIVE: The objective of this study was to examine the reliability of the measurement of stature in individuals with severe motor and intellectual disabilities. METHODS: Using a stratified sampling method 12 subjects (mean age of 28.7 +/- 11.5), were selected from 73 subjects with severe motor and intellectual disabilities (mean age of 37.1 +/- 15.0). Each subjects'stature was measured using two measurement methods. One measured the tibia length (TL-method) and, the other measured the whole body by measuring three sections. (Division-method). 3 examiners measured all subjects using the TL-method and Division-method two times repeatedly. In addition, one examiner measured all subjects within two weeks following the initial measurement. Intra-rater reliability was calculated from single and two times measurements using each method. The Inter-rater reliability was calculated using measurement results from 2 or 3 examiners in both single and two times measurements. The correlation between values measured by the TL-method and the Division-method was calculated using Spearman rank correlation coefficient. RESULTS: The TL-method and Division-method had good intra-rater reliability (ICC>0.90, 95%CI>0.80) and good inter-rater reliability (ICC>0.90, 95%CI>0.70) in both measurement methods. For both measurement methods, inter-rater reliability was more preferable when 3 examiners measured two times repeatedly (ICC>0.90, 95%CI>0.90). There was good correlation between values measured by TL-method and the Division-method (r=0.83). CONCLUSIONS: Both TL-method and Division-method had good reliability. However, the TL-method could be considered a more useful measurement method as it can be completed more easily and in a short period of time.

Snake fetuin: isolation and structural analysis of new fetuin family proteins from the sera of venomous snakes.

Novel proteins were isolated from the sera of Chinese Mamushi (Gloydius blomhoffi brevicaudus) and Habu (Trimeresurus flavoviridis). The primary structures of these proteins were determined by protein sequencing, and the nucleotide sequences were established by cDNA cloning from the liver mRNAs. They belonged to the fetuin family having a double-headed cystatin-like domain and a His-rich domain, akin to HSF, an antihemorrhagic factor isolated from Habu serum. They showed no antihemorrhagic activity and were designated HSF-like proteins (HLPs). Mamushi serum contained two different HLPs termed HLP-A and HLP-B. Both HLP-A and Habu HLP had a unique 17-residue deletion in their His-rich domains. HLP-B comprised two glycosylated polypeptide chains and inhibited the precipitation of calcium phosphate as potently as does bovine fetuin. HLP-B was hence identified as a snake fetuin. The phylogenetic analysis of the fetuin family of proteins showed that antihemorrhagins and HLPs have evolved from this snake fetuin.

Effects of hyperbaric oxygen exposure on experimental hepatic ischemia reperfusion injury: relationship between its timing and neutrophil sequestration.

Recent studies have shown that hyperbaric oxygen therapy (HBOT) reduces neutrophil endothelial adherence in venules and also blocks the progressive arteriolar vasoconstriction associated with ischemia-reperfusion (I-R) injury in the extremities and the brain. In order to elucidate the effects of HBOT after I-R in digestive organs, particularly in the liver, we evaluated the following: 1) the relationship between timing of HBOT and tissue damage; and 2) HBOT's effects on neutrophil sequestration. Using a hepatic I-R (45 minute) model in male rats, survival rate, liver tissue damage, and neutrophil accumulation within the sinusoids in the HBOT-treated group (Group H) were compared to those in the nontreated group (Group C). For the HBOT-treated group, HBOT was administered as 100% oxygen, at 2.5 atm absolute, for 60 minutes. When HBOT was given 30 minute after I-R, the survival rate was much better in Group H than in Group C. HBOT performed within 3 hours of I-R markedly suppressed increases in the malondialdehyde level in tissues of the liver and lessened the congestion in the sinusoids. In addition, HBOT just after I-R caused decreased number of cells stained by the naphthol AS-D chloroacetate esterase infiltrating into the sinusoids. HBOT 3 hours after reperfusion, however, showed no clear effects upon neutrophil sequestration compared to Group C. These results indicate that HBOT performed within 3 hours of I-R alleviates hepatic dysfunction and improves the survival rate after I-R. Herein, we propose 1 possible mechanism for these beneficial effects: early HBOT given before neutrophil-mediated injury phase may suppress the accumulation of neutrophils after I-R. In conclusion, we believe that the present study should lead to an improved understanding of HBOT's potential role in hepatic surgery.

A potential role of hyperbaric oxygen exposure through intestinal nuclear factor-kappaB.

OBJECTIVE: Recent studies have demonstrated the therapeutic effectiveness and pharmacologic mechanisms of hyperbaric oxygen therapy (HBOT) in the treatment of a systemic shock state. To elucidate the in vivo role of HBOT during sepsis, we evaluated the effects of HBOT on intestinal mucosal injury and bacterial translocation after lipopolysaccharide challenge. DESIGN: Experimental study. SETTING: First Department of Surgery and Division of Emergency Care, Kagoshima University School of Medicine, Kagoshima, Japan. SUBJECTS: : Male rats were treated with lipopolysaccharide by an intraperitoneal route or with lipopolysaccharide and HBOT. INTERVENTIONS: The survival rate, small intestinal tissue damage, and bacterial translocation in the HBOT-treated group were compared with those in the untreated group. Moreover, plasma tumor necrosis factor-alpha and nitrite/nitrate concentrations, inducible nitric oxide synthase and myeloperoxidase activities, and nuclear factor-kappaB in ileal mucosa were investigated. HBOT was initiated 3 hrs after lipopolysaccharide challenge and administered as 100% oxygen, at 2.53 x 10 kPa (2.5 atm absolute), for 60 mins. MEASUREMENTS AND MAIN RESULTS: When a sublethal dose of lipopolysaccharide (24 mg/kg) was given, the survival rate was much better in the HBOT-treated group (75%) than in the untreated group (33%). HBOT given 3 hrs after lipopolysaccharide injection (10 mg/kg) also lessened the histologic tissue damage of the terminal ileum and the incidence and magnitude of bacterial translocation to mesenteric lymph nodes at 24 hrs after the lipopolysaccharide injection. Moreover, HBOT was able to reduce mucosal inducible nitric oxide synthase and myeloperoxidase activities and plasma nitrite/nitrate concentrations but not serum tumor necrosis factor-alpha concentrations. Immunohistochemical examination revealed that HBOT specifically modified the mucosal nuclear factor-kappaB activation within 4-6 hrs after the injection. CONCLUSIONS: HBOT performed 3 hrs after lipopolysaccharide challenge alleviates intestinal barrier dysfunction and improves survival rates. Herein, we propose one possible mechanism for these beneficial effects: HBOT can modify the nuclear factor-kappaB activation in the intestinal mucosa and attenuate the sequential nitric oxide overproduction and myeloperoxidase activation. Consequently, bacterial translocation could be potentially decreased. We believe that the present study should lead to an improved understanding of HBOT's potential role in sepsis.

Quality of life after hepatectomy in patients with hepatocellular carcinoma: implication of change in hepatic protein synthesis.

BACKGROUND/AIMS: Surgical removal has been accepted as a therapeutic option for hepatocellular carcinoma. However, little is known about the quality of life after hepatectomy for hepatocellular carcinoma. In this report, we describe the risk factors most affecting impaired quality of life after partial hepatectomy in patients with hepatocellular carcinoma. METHODOLOGY: Ninety-six patients who received curative resections 12-60 months previously, answered our original questionnaire, mailed to them. The questions consisted of 14 items concerning physical function, social function, psychological function, physical sensation, and recognition of the disease, with a scoring system of 1, 2, and 3. Based on the pre- and postoperative serum alanine aminotransferase or cholinesterase levels at 3-month intervals during the follow-up period, the changes were classified into three types: those staying in the favorable or unfavorable range at one year (no change, Type 1 or Type 3), and those entering the unfavorable range postoperatively (Type 2). RESULTS: Total quality of life score: the sum of scores to questions 1-12, displayed two peaks of normal distribution. Based on a point of intersection of the two curves: i.e., score of 22, the patients were classified into 2 groups: those with preserved quality of life (n = 75) i.e., total quality of life scores of 12-21, and impaired quality of life, scores of 22 or more (n = 21). Older age (> or = 65 y) at hepatectomy, in the course of treatment for recurrence, and Type 2 change of serum cholinesterase level were associated with the impaired quality of life. Multivariate analysis revealed that Type 2 change of serum cholinesterase levels was an independent risk factor for an impaired quality of life. Furthermore, the patients exhibiting Type 2 change of serum cholinesterase levels were clearly impaired in their physical and social functions compared to the other patients. Hepatitis-related or cancer-related factors showed no correlation with the deterioration of the quality of life. CONCLUSIONS: The quality of life after hepatectomy in patients with hepatocellular carcinoma was impaired in cases of aged patients, treatment for recurrence, and Type 2 change of the serum cholinesterase level. Postoperative maintenance of protein synthesis including cholinesterase is one measure to preserve a satisfactory quality of life after hepatectomy.