For lower limb amputees, good prosthetic fittings are important for wearing prostheses while ensuring gait stability, without skin breakdown. Poor prosthetic fittings tend to occur in the early stage after amputation because of significant changes in residual limb volume. We measured the extent of change in residual limb volume in three below-the-knee amputees by using computed tomography. The measurements were performed before and after inpatient rehabilitation for the first prosthesis. The measurement showed a remarkable change in residual limb volume in a highly active amputee without complications. In contrast, the change in residual limb volume was small in two less active below-the-knee amputees with serious complications, such as heart and renal failures. Generally, to maintain good prosthetic fittings, the first prostheses should be made during inpatient rehabilitation to facilitate maturation of the residual limbs. For the less active below-knee amputees, the prostheses could be made in the outpatient settings because the volume fluctuations of their residual limbs are small and the functional requirements for their daily living are modest.

We conducted a study to evaluate the efficacy of mashiningan for constipation in Parkinson's disease. Twenty-three patients with constipation in Parkinson's disease were enrolled and were evaluated after 1 month in this study. The mashiningan efficacy endpoint in the study was bowel movement frequency. We categorized treatment effect as “effective”, “ineffective”, and “worsened” to calculate increased, unchanged, and decreased bowel movement frequencies, respectively. Previously administered laxative was also switched to mashiningan and subsequent effect was evaluated as well. Mashiningan was effective in 78.3% of patients, and there were no patients determined to have “worsened”. The only adverse effect was diarrhea which was noted in 13.0% of patients. Mashiningan was effective in 86.7% of the 15 patients without laxative administration history, and was effective in 62.5% of 8 patients who had taken laxative previously. Therefore, mashiningan showed a higher degree of efficacy in the patients off medication for constipation. Additionally, mashiningan could be safely switched to from other laxatives without worsening constipation. In conclusion, mashiningan is a useful medication for the treatment of constipation in Parkinson's disease.

We report the rare case of a 68-year-old man, who was admitted to our hospital with a diagnosis of aortic arch anastomotic pseudoaneurysm, with concomintant aortic root enlargement and coronary artery stenosis. Eleven years previously, at age 56, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed redo total arch replacement, aortic root replacement and coronary artery bypass, making use of a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery and femoral vein before resternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation ; however, he was discharged in good condition on the 50th post-operative day. The case suggests that island reconstruction has the potential to cause an aortic arch pseudoaneurysm, particularly after a long postoperative period of time. Therefore, thorough postoperative care strategy is required. We also need to consider surgical reconstructive techniques which eliminate vascular lesions as much as possible at the time of the primary surgery, particularly in cases of chronic aortic dissection.

Background: Rotavirus vaccines were introduced in Japan in November 2011. We evaluated the subsequent reduction of the health-care burden of rotavirus gastroenteritis. Methods: We conducted active surveillance for rotavirus gastroenteritis among children under 5 years old before and after the vaccine introduction. We surveyed hospitalization rates for rotavirus gastroenteritis in children in Tsu City, Mie Prefecture, Japan, from 2007 to 2015 and surveyed the number of outpatient visits at a Tsu City clinic from 2010 to 2015. Stool samples were obtained for rotavirus testing and genotype investigation. We assessed rotavirus vaccine coverage for infants living in Tsu City. Results: In the pre-vaccine years (2007-2011), hospitalization rates for rotavirus gastroenteritis in children under 5 years old were 5.5, 4.3, 3.1 and 3.9 cases per 1000 person-years, respectively. In the post-vaccine years (2011-2015), the rates were 3.0, 3.5, 0.8 and 0.6 cases per 1000 person-years, respectively. The hospitalization rate decreased significantly in the 2013-2014 and 2014-2015 seasons compared to the average of the seasons before vaccine introduction (p < 0.0001). In one pre-vaccine year (2010-2011), the number of outpatient visits due to the rotavirus infection was 66. In the post-vaccine years (2011-2015), the numbers for each season was 23, 23, 7 and 5, respectively. The most dominant rotavirus genotype shifted from G3P[8] to G1P[8] and to G2P[4]. The coverage of one dose of rotavirus vaccine in Tsu City was 56.5% in 2014. Conclusion: After the vaccine introduction, the hospitalization rates and outpatient visits for rotavirus gastroenteritis greatly decreased.

STUDY DESIGN: Gait analysis of patients with cervical spondylotic myelopathy (CSM) by using a sheet-type gait analysis system. PURPOSE: The aim of this study was to compare the gait patterns of patients with CSM, evaluated by the Nurick grades, and to determine the threshold values of gait parameters predicting the occurrence of a fall by using a gait recorder. OVERVIEW OF LITERATURE: Gait disorder due to CSM may progress to severe paraplegia, following even a minor trauma such as a fall. The indications for the surgery of CSM without severe paralysis remain controversial. The quantitative gait analysis and the decision for decompressive surgery in patients with CSM are important in order to prevent severe paraplegia from a fall. METHODS: One hundred thirty-two subjects (normal, 34; CSM, 98) underwent gait analysis by using a sensor sheet. Measurements of gait cycle parameters included the step and stride length, step width, foot angle, swing phase, and stance phase. CSM was assessed by Nurick grade. RESULTS: Although the clinical symptoms were lacking, Nurick grade 1 had significant abnormalities in the parameters of velocity, step length, and step angle (p<0.05). Regarding the Nurick grade and walking phase, the length of the stance phase was increased to more than 70% of the entire walking cycle in Nurick grade 4. CONCLUSIONS: Gait analysis was an objective tool for evaluating the gait stability. Our results suggested that when the percentage of the stance phase in the gait cycle increases to above 70%, the CSM patients have an increased fall risk.
Foot ; Gait* ; Humans ; Movement Disorders ; Paralysis ; Paraplegia ; Physical Examination ; Spinal Cord Diseases* ; Walking

STUDY DESIGN: Normal cervical sagittal length patterns were measured by magnetic resonance imaging (MRI). PURPOSE: The aim of this study was to evaluate the relationship of sagittal length patterns between the cervical cord and the cervical canal in flexion-extension kinematics. OVERVIEW OF LITERATURE: Cervical dynamic factors sometimes cause a cervical spondylotic myelopathy in elderly subjects and an overstretching myelopathy in juvenile subjects. Previous studies showed the length changing of the cervical cord in flexion and extension. However, there is no detailed literature about the relationship between cervical vertebral motion and cord distortion yet. METHODS: Sixty-two normal subjects (28 male and 34 female, 42.1+/-8.5 years old) without neck motion disturbances and abnormalities on cervical X-ray and MRI were enrolled in this study. RESULTS: The cervical cord length was significantly longer in flexion and significantly shorter in extension in all cervical cord sagittal lines. The cervical canal length pattern was also the same as the cervical cord. The elongation of the cervical cord and canal was the largest at the site of the posterior cervical canal and the shortest at the anterior canal site. The positions of the cerebellar tonsils were verified at each neck position. CONCLUSIONS: The posterior elements of the cervical canal were most affected by neck motion. Movement directions of the upper cervical cord were verified among the various neck positions.
Aged ; Biomechanical Phenomena ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Neck* ; Palatine Tonsil ; Spinal Cord Diseases

STUDY DESIGN: Radiological analysis of normal patterns of sagittal alignment of the spine. PURPOSE: This study aimed to clarify the characteristics of normal sagittal spino-pelvic alignment in Asian people. OVERVIEW OF LITERATURE: It is known that there are differences in these parameters based on age, gender, and race. In order to properly plan for surgical correction of the spine for Asian patients, it is necessary to understand the normal spino-pelvic alignment parameters for this population. METHODS: This study analyzed 86 Japanese healthy young adult volunteers (48 men and 38 women; age 35.9+/-11.1 (mean+/-standard deviation [SD]). The following parameters were measured on lateral standing radiographs of the entire spine: sagittal vertical axis (SVA), horizontal distance between the C7 plumb line and the posterior superior corner of the superior margin of S1, thoracic kyphotic angle (TK), lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). RESULTS: The values (mean+/-SD) of SVA, TK, LLA, SS, PT, and PI were 8.45+/-25.7 mm, 27.5+/-9.6degrees, 43.4+/-14.6degrees, 34.6+/-7.8degrees, 13.2+/-8.2degrees, and 46.7+/-8.9degrees, respectively. The Japanese young adults evaluated in this study tended to have a smaller PI, LLA, TK, and SVA than most Caucasian people. Regarding gender differences, SVA was significantly longer and TK was significantly smaller in men; however, there was no statistically significant difference in LLA, SS, PA, and PI. CONCLUSIONS: Japanese young adults apparently have smaller PI and LLA values than Caucasian people. When making decisions for optimal sagittal spinal alignment, racial differences should be considered.
Asian Continental Ancestry Group* ; Axis, Cervical Vertebra ; Continental Population Groups ; Female ; Humans ; Incidence ; Male ; Spine ; Volunteers ; Young Adult*

Dang Gui Liu Huang Tang (in the Lan Shi Mi Cang written by Li Dong-yuan) is a common medicine for treating night sweats. We describe its historical development and therapeutic uses. The use of Huan qi (Radix Astragali sen Hedysari) is based on the Han-Sui dynasty medical principle that night sweats are mainly caused by Deficiency of Yang. Herbs to enrich the lood and Yin, Dang gui (Radix Angelicae Sinesis), Seng di huang (Radix Remannia), Shu di huang Radix Rehmannia preparata) were later added because Son dynasty physicians mentioned that Yin deficiency caused night sweats. The addition of heat-reducing herbs, such as Huang lian (Rhizoma Coptidis), was based on the Song dynasty theory that night sweats are caused by pathologic heat in the body, which forces body fluid out of the skin. In the same period, the herbal medicine called Da Jin Hua Wan created by Liu Wansu, and this greatly influenced the principles for treating night sweats. The clearest explanation can be found in the medical treaties Huang Di Nei Jing Su Wen, and Xuan Ming Lun. This medical combination was based on medical theories from a number of historical periods, which may explain its effectiveness. Dang Gui Liu Huang Tang is not effective against types of weak heat (Dan xin xin fa), severe vital Qi Deficiency (Zhang shi yang), or serious deficiency of Yin (Yi xue xin wu). It sometimes hurts Pi and Wei (digestive system). It is useful in the treatment of spontaneous perspiration (Yi xue zheng zhuang, Jin xue quan shu). In summary, this medicine is most effective when the seriousness of heat and Yin deficiency are almost equal and a slight Qi Deficiency exists, or in cases of spontaneous perspiration.

Until the Sui Dynasty in China, night sweat and spontaneous perspiration had been thought to be caused by same pathophysiology, that is, lowered superficial resistance by deficiency of Qi.In the Tang Dynasty, these were considered to have different pathophysiologies and a new principle indicated that pathogenic heat caused night sweat.In the Song and Jing Dynasties, deficiency of blood and pathogenic heat by deficiency of Yin was also considered to cause night sweat.In the Jing Dynasty, exogenous pathogens, such as Cold were considered to cause night sweat, which indicated the principle that not only the deficiency syndrome but also the excess syndrome caused night sweat.In the beginning of the Yuan and Ming Dynasties, it was concluded that the deficiency of Yin caused night sweat and the deficiency of Yang caused spontaneous perspiration.In the middle of the Ming Dynasty, another new theory indicated that deficiency of Yang also possibly caused night sweat; therefore we should diagnose abnormal sweat depending on the pathophysiology in each case.In the Qing Dynasty, new theories were established stating that not only exogenous pathogens but also Damp-heat, undigested food and stagnation of blood, all of which are included in excess syndrome, cause night sweat, and that based on which part of the body sweats occurred we might understand pathophysiology of night sweat. The night sweat by Warm-heat, which is different from the one by Wind-cold, was considered to be caused with deficiency of Yin.Thus we conclude that the theories of night sweat developed over time, based on Chinese medical classics.