Abnormalities of the First Three Steps of Gait Initiation in Patients with Parkinson's Disease with Freezing of Gait

The purpose of this study was to investigate abnormalities of the first three steps of gait initiation in patients with Parkinson's disease (PD) with freezing of gait (FOG). Ten PD patients with FOG and 10 age-matched healthy controls performed self-generated gait initiation. The center of pressure (COP), heel contact positions, and spatiotemporal parameters were estimated from the vertical pressures on the surface of the force platform. The initial swing side of gait initiation was consistent among the trials in healthy controls but not among the trials in PD patients. The COP and the heel contact position deviated to the initial swing side during the first step, and the COP passed medial to each heel contact position during the first two steps in PD patients. Medial deviation of the COP from the first heel contact position had significant correlation with FOG questionnaire item 5. These findings indicate that weight shifting between the legs is abnormal and that medial deviation of the COP from the first heel contact position sensitively reflects the severity of FOG during the first three steps of gait initiation in PD patients with FOG

Analysis of Radioactive Elements in Testes of Large Japanese Field Mice Using an Electron Probe Micro-Analyser after the Fukushima Accident

The Fukushima Daiichi nuclear power plant (FDNPP) accident drew global attention to the health risks of radiation exposure. The large Japanese field mice (Apodemus speciosus) are rodents endemic to, and distributed throughout, Japan. This wild rodent live in and around the ex-evacuation zone on the ground surface and/or underground. In this study, we evaluated the effect of chronic radiation exposure associated with FDNPP accident on the testes of large Japanese field mice. Morphological analysis and electron-prove X-ray microanalysis (EPMA) was undertaken on the testes. Morphological analysis of testes based on H&E staining showed that the spermatogenesis was observed normally in the breeding season of wild mice in the heavily contaminated area. However, caesium (Cs) was not detected in all testes of wild mice from FDNPP ex-evacuation zone. In conclusion, even if the testes and the process of spermatogenesis are hypersensitive to radiation, we could not detect radiation effects on the spermatogenesis and Cs in the examined large Japanese field mice testes following chronic radiation exposure associated with the FDNPP accident

Quality of care associated with number of cases seen and self-reports of clinical competence for Japanese physicians-in-training in internal medicine

BACKGROUND: The extent of clinical exposure needed to ensure quality care has not been well determined during internal medicine training. We aimed to determine the association between clinical exposure (number of cases seen), self- reports of clinical competence, and type of institution (predictor variables) and quality of care (outcome variable) as measured by clinical vignettes. METHODS: Cross-sectional study using univariate and multivariate linear analyses in 11 teaching hospitals in Japan. Participants were physicians-in-training in internal medicine departments. Main outcome measure was standardized t-scores (quality of care) derived from responses to five clinical vignettes. RESULTS: Of the 375 eligible participants, 263 (70.1%) completed the vignettes. Most were in their first (57.8%) and second year (28.5%) of training; on average, the participants were 1.8 years (range = 1–8) after graduation. Two thirds of the participants (68.8%) worked in university-affiliated teaching hospitals. The median number of cases seen was 210 (range = 10–11400). Greater exposure to cases (p = 0.0005), higher self-reports of clinical competence (p = 0.0095), and type of institution (p < 0.0001) were significantly associated with higher quality of care, using a multivariate linear model and adjusting for the remaining factors. Quality of care rapidly increased for the first 100 to 200 cases seen and tapered thereafter. CONCLUSION: The amount of clinical exposure and levels of self-reports of clinical competence, not years after graduation, were positively associated with quality of care, adjusting for the remaining factors. The learning curve tapered after about 200 cases