Modulation of plantar pressure and gastrocnemius activity during gait using electrical stimulation of the tibialis anterior in healthy adults

<div><p>High plantar flexor moment during the stance phase is known to cause high plantar pressure under the forefoot; however, the effects on plantar pressure due to a change of gastrocnemius medialis (GM) activity during gait, have not been investigated to date. Reciprocal inhibition is one of the effects of electrical stimulation (ES), and is the automatic antagonist alpha motor neuron inhibition which is evoked by excitation of the agonist muscle. The aim of this study was to investigate the influences of ES of the tibialis anterior (TA) on plantar pressure and the GM activity during gait in healthy adults. ES was applied to the TAs of twenty healthy male adults for 30 minutes at the level of intensity that causes a full range of dorsiflexion in the ankle (frequency; 50 Hz, on-time; 10 sec, off-time; 10 sec). Subjects walked 10 meters before and after ES, and we measured the peak plantar pressure (PP), pressure time integral (PTI), and gait parameters by using an F-scan system. The percentage of integrated electromyogram (%IEMG), active time, onset time, peak time, and cessation time of TA and GM were calculated. PP and PTI under the forefoot, rear foot, and total plantar surface significantly decreased after the application of ES. Meanwhile, changes of gait parameters were not observed. %IEMG and the active time of both muscles did not change; however, onset time and peak time of GM became significantly delayed. ES application to the TA delayed the timing of onset and peak in the GM, and caused the decrease of plantar pressure during gait. The present results suggest that ES to the TA could become a new method for the control of plantar pressure via modulation of GM activity during gait.</p></div

Favorable Event Free-Survival of High-Dose Chemotherapy followed by Autologous Hematopoietic Stem Cell Transplantation for Higher Risk Diffuse Large B-Cell Lymphoma in First Complete Remission

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been applied to patients with diffuse large B-cell lymphoma (DLBCL); it is well established that ASCT shows significant survival benefits for chemosensitive relapse. However, half of relapsed patients are resistant to salvage chemotherapy, indicating that they are not suitable for ASCT. We retrospectively analyzed the clinical records of 47 patients with DLBCL classified as high or high-intermediate (higher) risk, according to the International Prognostic Index, who underwent upfront ASCT in first complete remission (CR1). Compared with 10 patients with similar characteristics who did not receive ASCT, event free survival at 5-year was significantly superior in ASCT group. Toxicity of ASCT was acceptable and therapy-related death was not observed. We therefore propose that upfront ASCT for higher risk DLBCL in CR1 might provide survival benefit, probably because the high-dose therapy removes minimally resided tumor

Duration of each gait cycle before and after ES application.

<p>The white one indicates HS-FF, FF, FF-TO, HS-FF + FF and FF + FF-TO before ES application. The gray one indicates these parameters after ES application. Density plot shows the distribution shape of the data. The thick black bar in the center represents the interquartile range, the thin black line extended from it represents the 95% confidence intervals, and the white dot is the median. The sum of HS–FF and FF is the contact duration of rear foot, and the sum of FF and FF–TO is the contact duration of forefoot. * represents a significant difference from pre-ES period (<i>P <</i> 0.05). Abbreviations: HS, heel strike; FF, foot-flat; TO, toe-off.</p

Peak pressure (PP) under the three regions (rear foot, midfoot, forefoot) and total plantar surface before and after ES application.

<p>The white bar indicates PP before ES application and the gray bar indicates PP after ES application. * represents a significant difference from pre-ES period (P < 0.05).</p

Pressure time integral (PTI) under the three regions (rear foot, midfoot, forefoot) and total plantar surface before and after ES application.

<p>The white bar indicates PTI before ES application and the gray bar indicates PTI after ES application. * represents a significant difference from pre-ES period (P < 0.05).</p

Normalized EMG data as activity of GM and TA during gait.

<p>Normalized EMG data as activity of GM and TA during gait.</p

Spatiotemporal parameters during gait.

<p>Spatiotemporal parameters during gait.</p

Dorsiflexion range of motion of ankle.

<p>Dorsiflexion range of motion of ankle.</p