Objective: This study aimed to identify the clinical characteristics of patients achieving independent gait through Robot-Assisted Gait Training, based on their condition at the onset of the training.Methods: The subjects were patients after stroke who underwent 4 weeks of gait training using the Hybrid Assistive Limb® (HAL, Cyberdyne, Inc.). The assessment items were Functional Ambulation Categories (FAC), Stroke Impairment Assessment Set (SIAS), Fugl-Meyer Assessment (FMA) for lower extremity, Berg Balance Scale (BBS), Functional Independence Measure (FIM), and Hasegawa Dementia Scale-Revised (HDS-R). Patients with a FAC score of 3 or higher were classified as the independent group, while those with a FAC score of 2 or lower were classified as the assistance group. A univariate analysis was conducted with a significance level set at 5%.Results: Ten patients were in the independent group (mean age 73.2±13.8 years), while 7 patients were in the assistance group (mean age 83.6±6.1 years). The independent group demonstrated significantly higher scores in SIAS total score, BBS, FIM, and HDS-R (p<0.05). Additionally, the SIAS subscales assessing knee joint function, lower limb range of motion, abdominal muscle strength, verticality, and quadriceps muscle strength on the non-paralyzed side were all significantly higher in the independent group (p<0.05).Conclusion: Patients achieving independent gait through training with HAL were younger, exhibited lower levels of functional disability, demonstrated better balance, and showed a greater capacity to perform activities of daily living and cognitive function.

Objective: This study aimed to identify the clinical characteristics of patients achieving independent gait through Robot-Assisted Gait Training, based on their condition at the onset of the training.Methods: The subjects were patients after stroke who underwent 4 weeks of gait training using the Hybrid Assistive Limb® (HAL, Cyberdyne, Inc.). The assessment items were Functional Ambulation Categories (FAC), Stroke Impairment Assessment Set (SIAS), Fugl-Meyer Assessment (FMA) for lower extremity, Berg Balance Scale (BBS), Functional Independence Measure (FIM), and Hasegawa Dementia Scale-Revised (HDS-R). Patients with a FAC score of 3 or higher were classified as the independent group, while those with a FAC score of 2 or lower were classified as the assistance group. A univariate analysis was conducted with a significance level set at 5%.Results: Ten patients were in the independent group (mean age 73.2±13.8 years), while 7 patients were in the assistance group (mean age 83.6±6.1 years). The independent group demonstrated significantly higher scores in SIAS total score, BBS, FIM, and HDS-R (p<0.05). Additionally, the SIAS subscales assessing knee joint function, lower limb range of motion, abdominal muscle strength, verticality, and quadriceps muscle strength on the non-paralyzed side were all significantly higher in the independent group (p<0.05).Conclusion: Patients achieving independent gait through training with HAL were younger, exhibited lower levels of functional disability, demonstrated better balance, and showed a greater capacity to perform activities of daily living and cognitive function.

Novel coronavirus disease (COVID-19) spread worldwide. In Japan, From April 16 to May 25, 2020, a state of emergency was declared and people were “strongly requested to refrain from going out unnecessarily and thoroughly reduce contact with others.” As a result, the number of steps of all generations was expected to be lower than usual due to the novel coronavirus disease pandemic. This study investigated the weather walking steps decrease in the collegiate student due to COVID-19. A total of 221 collegiate students used their smartphones to enter the average number of steps taken every month from January to May. The number of steps taken by all students was 4,988±2,345 steps in January, 5182±2,516 steps in February, 5,118±2,291 steps in March, 3,281±1,689 steps in April, and 2,834±1,676 steps in May. A comparison between sex groups showed that the number of steps in April and May was significantly different (p<0.05), which means that the steps of women group was lower than that of men. These results suggest that the number of steps taken by students decreased with the outbreak of the novel coronavirus disease.

OBJECTIVES: Increasing bone mineral density (BMD) to reduce fracture risk is a primary goal of osteoporosis treatment. This prospective, observational study evaluates the effects of monthly minodronate (MIN; 50 mg) with or without eldecalcitol (ELD) addition in osteoporosis patients with rheumatoid arthritis (RA) during 18 months. METHODS: The cohort was prospectively and randomly split into the MIN monotherapy group (14 cases) and MIN plus ELD group (combination group; 14 cases) due to no reports on the effectiveness and safety of MIN therapy in relation to ELD addition for comparisons of serum tartrate-resistant acid phosphatase (TRACP)-5b, bone alkaline phosphatase (BAP), and BMD of the lumbar 1–4 vertebrae (L-BMD), bilateral total hips (H-BMD; the mean value of the right and left hips), and bilateral femoral necks (FN-BMD) at baseline and at 6, 12, and 18 months of treatment. RESULTS: Baseline values were comparable between the groups apart from a tendency for higher TRACP5b in the combination group. Seven of 14 patients in the combination group had received previous bisphosphonate treatment. BAP was significantly more reduced in the monotherapy group at 6 months, with no other remarkable differences for TRACP5b, L-BMD, H-BMD, or FN-BMD during the observation period. CONCLUSIONS The above findings suggest that regardless of ELD addition, MIN potentially improves BMD during 18 months in osteoporosis patients with RA.

OBJECTIVES: The aim of this study was to examine the efficacy, safety, and adherence of ibandronate (IBN) treatment with or without vitamin D supplementation for 3 years in Japanese women with postmenopausal osteoporosis. METHODS: This prospective investigation included 27 patients treated with IBN alone (monotherapy group) and 29 patients receiving IBN and alfacalcidol (ALF) (combination group). Bone metabolism and bone mineral density (BMD) were measured before and at 18, 24, 30, and 36 months of therapy. Treatment discontinuation and fracture occurrence were assessed as well. RESULTS: Lumbar 1–4 BMD (L-BMD) was significantly increased in the monotherapy and combination groups by 3.9% and 7.2%, respectively, at 36 months, with significant gains in total hip BMD (H-BMD) of 3.7% and 4.9%, respectively. There were significant differences in L-BMD improvement between the groups at 18, 24, and 30 months (P < 0.05) and at 36 months (P < 0.01). Compared with pretreatment levels, the percentage changes of L-BMD and H-BMD were significant at all time points in the combination group and at all points apart from L-BMD at 36 months in the monotherapy group. In the monotherapy group, 14 patients dropped out during 3 years and 2 vertebral fractures occurred during the first year. In the combination group, 16 cases dropped out during 3 years and 1 nonvertebral fracture was noted during the first year. CONCLUSIONS: Our findings suggest that combination therapy of IBN and vitamin D is superior to monotherapy with regard to L-BMD improvements for 3 years, with both groups showing comparable safety and adherence to treatment.
Asian Continental Ancestry Group ; Bone Density ; Compliance ; Female ; Hip ; Humans ; Metabolism ; Osteoporosis ; Osteoporosis, Postmenopausal ; Prospective Studies ; Vitamin D

The electrogenic sodium/bicarbonate cotransporter 1 (NBCe1) on the basolateral side of the renal proximal tubule plays a pivotal role in systemic acid-base homeostasis. Mutations in the gene encoding NBCe1 cause severe proximal renal tubular acidosis accompanied by other extrarenal symptoms. The proximal tubule reabsorbs most of the sodium filtered in the glomerulus, contributing to the regulation of plasma volume and blood pressure. NBCe1 and other sodium transporters in the proximal tubule are regulated by hormones, such as angiotensin II and insulin. Angiotensin II is probably the most important stimulator of sodium reabsorption. Proximal tubule AT(1A) receptor is crucial for the systemic pressor effect of angiotensin II. In rodents and rabbits, the effect on proximal tubule NBCe1 is biphasic; at low concentration, angiotensin II stimulates NBCe1 via PKC/cAMP/ERK, whereas at high concentration, it inhibits NBCe1 via NO/cGMP/cGKII. In contrast, in human proximal tubule, angiotensin II has a dose-dependent monophasic stimulatory effect via NO/cGMP/ERK. Insulin stimulates the proximal tubule sodium transport, which is IRS2-dependent. We found that in insulin resistance and overt diabetic nephropathy, stimulatory effect of insulin on proximal tubule transport was preserved. Our results suggest that the preserved stimulation of the proximal tubule enhances sodium reabsorption, contributing to the pathogenesis of hypertension with metabolic syndrome. We describe recent findings regarding the role of proximal tubule transport in the regulation of blood pressure, focusing on the effects of angiotensin II and insulin.
Acidosis, Renal Tubular ; Angiotensin II ; Blood Pressure* ; Diabetic Nephropathies ; Homeostasis ; Humans ; Hypertension ; Insulin ; Insulin Resistance ; Kidney Tubules, Proximal ; Plasma Volume ; Rabbits ; Rodentia ; Sodium ; Sodium-Bicarbonate Symporters

OBJECTIVES: The aim of this study was to examine the discontinuation and occurrence of fracture during denosumab treatment in Japanese women with primary osteoporosis or rheumatoid arthritis (RA) with osteoporosis. METHODS: This retrospective study included 143 patients with primary osteoporosis and 96 patients with RA and osteoporosis who were treated with denosumab. Treatment discontinuation, fracture occurrence, lumbar spine (L1–4) bone mineral density (LS-BMD), and bilateral total hip BMD (TH-BMD) were examined before and at 1 and 2 years after treatment commencement. RESULTS: In the primary osteoporosis group, 32 cases dropped out and no fractures occurred from 0 to 1 year. Eighteen cases were lost to follow-up and no fractures were noted from 1 to 2 years. In the RA with osteoporosis group, 7 cases dropped out and no fracture occurred from 0 to 1 year. Twenty-one cases were lost to follow-up and 2 nonvertebral fractures were noted from 1 to 2 years. In this group, 13 cases dropped out from 1 to 2 years and 16 cases dropped out during the 2-year study period due to economic reasons. LS-BMD and TH-BMD values increased continuously for 2 years of treatment in both primary osteoporosis and RA with osteoporosis groups. CONCLUSIONS: These results suggest that during denosumab therapy, the discontinuation rate is expected to remain low during 2 years of treatment in primary osteoporotic patients. In RA patients with osteoporosis, however, the discontinuation rate may increase due to economic reasons from 1 to 2 years of therapy.
Arthritis, Rheumatoid* ; Asian Continental Ancestry Group* ; Bone Density ; Compliance* ; Denosumab* ; Female ; Hip ; Humans ; Lost to Follow-Up ; Osteoporosis* ; Retrospective Studies ; Spine

Objective: At Kitasato Institute Hospital, Kitasato University (henceforth, the hospital), the first edition of an antimicrobial use guidebook (henceforth, the guidebook) was produced in 2000.  This time, the Pharmaceutical Department’s members on the hospital’s Infection Control Committee (ICC) took the lead and revised the guidebook so that it better conforms to clinical conditions and assessed the guidebook they created.
Methods: A Working Group (WG) consisting of two ICC Pharmaceutical Department members and two members of the Medical Products Information Office staff examined the items to be listed in the guidebook.  These items were approved by the ICC and then assigned to physicians and pharmacists to be written up.  A questionnaire survey was conducted on the physicians and pharmacists in the hospital as to their assessment of the content and the conditions of use of the guidebook created.
Results: In the revised edition, “Antimicrobials PK/PD,” “TDM,” “Empiric Therapy for Infections in Each Department,” etc. have been added, the physicians wrote “Empiric Therapy for Infections in Each Department” and everything else was written by the WG.  The return rate of the questionnaire was 65.7% (N=99), and the guidebook utilization rate was 75.4%.  Frequently viewed items were “List of Antimicrobials Used In-Hospital,” “How to Administer Medication during Decreased Renal Function,” “Empiric Therapy for Infections in Each Department,” etc. by the internal medicine physicians, “List of Antimicrobials Used In-Hospital” and “How to Administer Medication during Decreased Renal Function,” etc. by the surgeons, and “Classification of Antimicrobials,” “List of Antimicrobials Used In-Hospital,” “When Renal Function is Decreased,” “TDM,” and “Empiric Therapy for Infections in Each Department,” etc. by the residents.  Furthermore, there were no items deemed “not necessary for inclusion” for a clear reason.  As to be expected in this guidebook, 72.3% of all respondents mentioned it was “a source of information on basic antimicrobial use” and next, “a source of information for treating infections outside one’s area of specialty.”
Conclusion: The items listed in the guidebook are thought to be appropriate, and its usage conditions are also good.  As they are specialists on antimicrobials, the pharmacists playing a central role while cooperating with the physicians on the ICC led to the creation of a highly useful guidebook.

The purpose of this study was to examine the effect of physical inactivity, produced by prolonged bed rest, on the excitability of the spinal motor neuron pool in humans, using the activity of soleus H-reflex.
Eight healthy male subjects underwent continuous bed rest with 6 degree head-down tilt for 20 days (BR group) . Ten different healthy male subjects maintained their usual daily life during the observation period for 20 days (control group) . Recruitment curves of H-reflex and M-wave were obtained from every subject. H slope/M slope (H slp/M sip) which shows the excitability of spinal motor neurons was calculated by using data in the recruitment curve.
The H sip/M sip in the BR group significantly increased after BR, compared to the pre-BR values (p<0.05) . In the control group, however, there were no significant differences in the H slp/M sip between the pre and the post-observation values. At the baseline, the H slp/M sip showed no significant differences between the BR group and the control group. After the BR, the H slp/M sip in the BR group significantly increased compared to the control group after the observation period (p<0.05) .
This study suggests that the excitability of the monosynaptic spinal motor neuron pool is facilitated by physical inactivity during BR.

AIMChromosome 13 is one of the most frequently altered chromosomes in prostate cancer. The present study was undertaken to examine the role of human chromosome 13 in the progression of prostate cancer.

METHODSHuman chromosome 13 was introduced into highly metastatic rat prostate cancer cells via microcell-mediated chromosome transfer.

RESULTSMicrocell hybrid clones containing human chromosome 13 showed suppression of metastasis to the lung without any suppression of tumorigenicity, except for one clone, which contained the smallest sized human chromosome 13 and did not show any suppression on lung metastasis. Expression of two known tumor suppressor genes, BRCA2 and RB1, which map to chromosome 13, was examined by reverse transcription- polymerase chain reaction analysis. BRCA2 was expressed only in the metastasis-suppressed microcell-hybrid clones, whereas RB1 was expressed in all clones.

CONCLUSIONHuman chromosome 13 contains metastasis suppressor gene(s) for prostate cancer derived from rat. Furthermore, the RB1 gene is unlikely to be involved in the suppression of metastasis evident in this system.

Animals ; Animals, Genetically Modified ; Cell Division ; genetics ; Chromosome Aberrations ; Chromosome Mapping ; Chromosomes, Human, Pair 13 ; Disease Progression ; Genetic Markers ; Humans ; In Situ Hybridization, Fluorescence ; Kinetics ; Male ; Neoplasm Metastasis ; Prostatic Neoplasms ; genetics ; pathology ; prevention & control ; Rats ; genetics