Efficacy of a Single-Bout of Auditory Feedback Training on Gait Performance and Kinematics in Healthy Young Adults.

This study investigated the immediate effects of auditory feedback training on gait performance and kinematics in 19 healthy young adults, focusing on bilateral changes, despite unilateral training. Baseline and post-training kinematic measurements, as well as the feedback training were performed on a treadmill with a constant velocity. Significant improvements were seen in step length (trained: 590.7 mm to 611.1 mm, 95%CI [7.609, 24.373]; untrained: 591.1 mm to 628.7 mm, 95%CI [10.698, 30.835]), toe clearance (trained: 13.9 mm to 16.5 mm, 95%CI [1.284, 3.503]; untrained: 11.8 mm to 13.7 mm, 95%CI [1.763, 3.612]), ankle dorsiflexion angle at terminal stance (trained: 8.3 deg to 10.5 deg, 95%CI [1.092, 3.319]; untrained: 9.2 deg to 12.0 deg, 95%CI [1.676, 3.573]), hip flexion angular velocity, (trained: -126.5 deg/s to -131.0 deg/s, 95%CI [-9.054, -2.623]; untrained: -130.2 deg/s to -135.3 deg/s, 95%CI [-10.536, -1.675]), ankle angular velocity at terminal stance (trained: -344.7 deg/s to -359.1 deg/s, 95%CI [-47.540, -14.924]; untrained: -340.3 deg/s to -376.9 deg/s, 95%CI [-37.280, -13.166s]), and gastrocnemius EMG activity (trained: 0.60 to 0.66, 95%CI [0.014, 0.258]; untrained: 0.55 to 0.65, 95%CI [0.049, 0.214]). These findings demonstrate the efficacy of auditory feedback training in enhancing key gait parameters, highlighting the bilateral benefits from unilateral training.

[Collaborative Study of an LC-MS/MS Method for Determination of Chlorpropham in Feeds].

A collaborative study for validating the determination method of chlorpropham in feeds by LC-MS/MS was conducted in 13 laboratories using 2 kinds of formula feeds, oats, barley, wheat, and corn. The resulting trueness ranged from 75.3 to 87.0%, repeatability and reproducibility in terms of relative standard deviation (RSDr and RSDR) were within 7.3% and 33% respectively, and the HorRat values ranged from 0.39 to 1.5. The limit of detection and limit of quantitation of chlorpropham in feed ware 0.008 mg/kg and 0.003 mg/kg, respectively. This method was thus validated as useful for inspections of chlorpropham in feed.

Effects of epidural anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery: a randomized controlled trial.

PURPOSE: Patients undergoing laparoscopic gynecological surgery are susceptible to postoperative nausea and vomiting (PONV). We hypothesized that a combination of epidural and general anesthesia to minimize intraoperative opioid administration would reduce the incidence of PONV following laparoscopic gynecological surgery. METHODS: Women undergoing elective laparoscopic gynecological surgery were randomly assigned to receive general anesthesia alone (group G, n = 45) or general anesthesia with epidural anesthesia (group GE, n = 45). Patients in group G received fentanyl and remifentanil for intraoperative analgesia, and those in group GE received single-shot ropivacaine at the time of induction of anesthesia. The primary outcome was the incidence of PONV within 24 h of surgery. Secondary outcomes included the use of rescue metoclopramide within 24 h of surgery and the time to first incidence of PONV and first use of rescue metoclopramide. RESULTS: The incidence of PONV within 24 h of surgery was 60.0% in group G and 44.4% in group GE [relative risk (RR): 0.53, 95% confidence interval (CI): 0.23-1.23, p = 0.14]. There were no intergroup differences in the use of rescue metoclopramide (40.0% in group G, 24.4% in group GE, RR: 0.49, 95% CI 0.20-1.20, p = 0.11) and the time to first incidence of PONV and first use of rescue metoclopramide (p = 0.20 and 0.12, respectively). CONCLUSION: Minimizing intraoperative opioid administration by combining epidural and general anesthesia did not reduce the 24-h incidence of PONV or rescue metoclopramide use after laparoscopic gynecological surgery.

Familial Dysalbuminemic Hyperthyroxinemia that was Inappropriately Treated with Thiamazole Due to Pseudo-thyrotoxic Symptoms.

We herein report the case of a Japanese woman with familial dysalbuminemic hyperthyroxinemia (FDH) who was initially diagnosed with Graves' disease. Direct genomic sequencing revealed a guanine to cytosine transition in the second nucleotide of codon 218 in exon 7 of the albumin gene, which then caused a proline to arginine substitution. She was finally diagnosed with FDH, which did not require treatment. FDH is - superficially - an uncommon cause of syndrome of inappropriate secretion of thyrotropin (SITSH) in Japan. A misdiagnosis of pseudo-hyperthyroidism will lead to inappropriate treatment. Thus, physicians should strongly note the possibility of FDH as a differential diagnosis of SITSH.

Dopamine-Secreting Paraganglioma in the Retroperitoneum.

Pheochromocytomas and paragangliomas, which exclusively produce dopamine, are very rare. Herein, we report for the first time a Japanese case of an exclusively dopamine-producing paraganglioma accompanied by detailed immunohistochemical analyses. A 70-year-old Japanese woman was referred to our hospital for functional examination of her left retroperitoneal mass. Her adrenal functions were normal, except for excessive dopamine secretion. After the tumorectomy, her dopamine level normalized. The histopathological diagnosis of the tumor was paraganglioma; this was confirmed by positive immunostaining of chromogranin A (CgA), tyrosine hydroxylase (TH), dopamine ß-hydroxylase (DBH), and succinate dehydrogenase gene subunit B (SDHB). However, the immunostaining of CgA in the tumor cells showed peculiar dot-like staining located corresponding to Golgi complex in the perinuclear area, rather than the diffuse cytoplasmic staining usually observed in epinephrine- or norepinephrine-producing functional pheochromocytomas and paragangliomas. The immunohistochemical results suggested that the tumor cells had sparse neuroendocrine granules in the cytoplasm, resulting in inhibition of catecholamine synthesis from dopamine to norepinephrine in neurosecretory granules. This may be the mechanism responsible for exclusive dopamine secretion in the present case.

Ectopic ACTH syndrome caused by desmopressin-responsive thymic neuroendocrine tumor.

A 32-year-old Chinese woman with rapid weight gain and progressive edema was found to have typical Cushingoid features. Her endocrine data were consistent with a diagnosis of ACTH-dependent Cushing's syndrome. To differentiate ectopic ACTH syndrome (EAS) from Cushing's disease (CD), various dynamic endocrine and imaging tests were performed. Her ACTH response was negative to corticotropin-releasing hormone (CRH) and positive to desmopressin. Magnetic resonance imaging of the pituitary showed no mass lesion. Computed tomography scan of the chest revealed a large mass (21 × 15 mm) in the anterior mediastinum, where positron emission tomography showed accumulation of [(18)F] fluorodeoxyglucose. Selective venous sampling showed marked step-up in ACTH level in the internal thoracic vein but not in the cavernous sinus after CRH stimulation. These data are compatible with the diagnosis of EAS. The resected tumor was pathologically consistent with thymic neuroendocrine tumor (NET) positive for ACTH by immunohistochemistry and abundant V1b receptor gene expression by RT-PCR. Postoperatively, her circulating ACTH/cortisol levels became normalized, and responded to stimulation with CRH but not with desmopressin. Her Cushingoid appearance gradually disappeared, and she was free from recurrence 5 years after surgery. This is a rare case of desmopressin-responsive EAS caused by thymic NET with predominant V1b gene expression, which was successfully localized by imaging modalities combined with selective venous sampling.

Investigation of whether CLSI broth microdilution method is applicable for MICs Determination of Enterococcus species.

The broth microdilution (BMD) method is an antimicrobial susceptibility testing method defined as a guideline by the Clinical and Laboratory Standards Institute (CLSI). To date, the Japanese Veterinary Antimicrobial Resistance Monitoring System (JVARM), has adopted the agar dilution (AD) method for monitoring antimicrobial resistances targeting isolates of Enterococcus spp., found in the fecal flora of food-producing animals, as indicator bacteria. However, the AD method is tedious, and time-consuming. In order to examine whether it could be replaced with the BMD method, the two methods were compared in terms of the correlation of MICs. In this study, the BMD results agreed with the AD results within ±1 log(2) dilutions in 72.3% of cases, except for the antimicrobial feed additive, Nosiheptide (NHT). Similarly, except for NHT, the MIC(50) and MIC(90) values obtained by the two methods were well correlated. In conclusion, our results indicate that the BMD method might be suitable for antimicrobial susceptibility testing targeting Enterococcus spp..

Sibling cases of Addison's disease caused by DAX-1 gene mutations.

We report two sibling cases of Addison's disease without any evidence of sexual precocity, adrenal hyperplasia, or autoimmune disease. The diagnosis of primary adrenocortical insufficiency was made at the age of 5 in the younger brother and at the age of 18 in the elder brother. The younger brother had been inactive during infancy and had diffuse skin pigmentation without abnormal external genitalia, while the elder brother had been healthy until the age of 17 when he noticed skin pigmentation and small testes. Both boys had delayed puberty due to hypogonadotropic hypogonadism. The diagnosis of adrenal hypoplasia congenita (AHC) was established by genetic analysis of DAX-1 gene (dosage-sensitive sex reversal-adrenal hypoplasia gene on the X chromosome, gene 1) with the same single frameshift mutation (305delG). However, yet-uncharacterized epigenetic, nongenetic and/or genetic factors other than the DAX-1 gene may be responsible for the differential onset of AHC in these sibling cases.

Reverse 'see-saw' relationship between Graves' disease and myasthenia gravis; clinical and immunological studies.

Although the association of two distinct autoimmune diseases, Graves' disease (GD) and myasthenia gravis (MG), is rare, the relationships of clinical and immunological activities between the two diseases remain unknown. In the present study, we investigated whether there exist any relationships between clinical and immunological activities of GD and MG as well as any common characteristics of their HLA antigens in five patients with concomitant association with GD and MG. The present study clearly showed positive relationships between the clinical activities of GD and MG in all five cases. Except for two cases, one with undetectable acetylcholine receptor antibody and another with few sample number, there were positive relationships between two circulating auto-antibodies against TSH receptor and acetylcholine receptor as well as their immunological and clinical activities in the remaining three cases. Furthermore, the present serological HLA typing study revealed that all five cases had common HLA-DQ3. Therefore, our study clearly demonstrates a reverse 'see-saw' relationship between GD and MG based on their clinical and immunological features, and suggests that HLA-DQ3 may play a potential pathogenic role in the concomitant development of the two diseases.