ANALYSIS OF REACHING MOVEMENTS WITH THE ADDITION OF RESISTANCE FORCES IN THE HORIZONTAL AND VERTICAL PLANES USING A ROBOT ARM IN NON-DISABLED INDIVIDUALS

A new, simpler, quantitative evaluation method, with higher reproducibility and validity than the conventional method used to evaluate hemiplegic upper extremities, is needed. The general properties of reaching movements were examined in healthy subjects by adding resistance forces to establish a new evaluation method using robotic technology. The subjects included 14 non-disabled males and 2 non-disabled females whose average age was 25 years. Their reaching movements were measured in both the horizontal and vertical planes with resistance force to add disturbance using a robot arm. Then, the jerk cost, the largest swinging distance, and the end¬point displacement were calculated. Significant differences were seen between subjects with and without disturbance in the horizontal jerk cost and largest swinging distance in the horizontal plane, and vertical jerk cost and largest swinging distance in the vertical plane. The horizontal and vertical jerk costs and largest swinging distances were also greater with a larger disturbance. In the reaching movements of healthy people in the horizontal and vertical planes, when the reaching movement was subjected to orthogonal disturbance, jerk cost and largest swinging distance in the direction of the disturbance were easily affected in response to the disturbance

Nivolumab-induced immune thrombocytopenia in a patient with malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is a rare and highly aggressive tumor. Nivolumab showed durable antitumor effect in patients with recurrent MPM and was approved for those patients in Japan in 2018. Immune related adverse event (irAE) is occurred in various organs and is suggestive to be related to better outcome of nivolumab. Frequency of hematological irAE is low and there are few reports about hematological irAE and association between irAE and outcome of nivolumab in patients with MPM. We present a case of recurrent MPM who responded to nivolumab treatment and experienced nivolumab-induced immune thrombocytopenia (ITP). Although high dose dexamethasone was administered and platelet count increased transiently, re-administration of dexamethasone was required to maintain normal count of platelet. The careful and intensive management of ITP treatment is necessary in cases who show no response or relapse to initial glucocorticoids treatment. This is the first report about nivolumab-induced ITP and association with response to nivolumab in MPM

CONSTRUCTION AND VALIDATION OF A NOVEL THREE-DIMENSIONAL TRUNK MUSCULOSKELETAL MODEL

Studies of internal biological forces during motion using musculoskeletal models have mainly focused on the extremities. Few reports have examined internal biological forces in spine motion using a trunk model. The aim of this study was to analyze detailed three-dimensional motion of healthy adults using a novel trunk model, and estimate internal biological forces in a standing position. We constructed a three-dimensional trunk musculoskeletal model. Dimensions of the vertebrae, other segments such as upper or lower extremities and muscles were based on a 31-year-old healthy man. Joint angle data for trunk and extremities kinematics were obtained from a standing position using a three-dimensional motion analysis system. To analyze motion of the spine in detail, we applied markers to three different places in each vertebral body from C7 to L5. Flexion moments accorded with spinal curvature at the apex of curvature of the thoracic spine at T8-9. Mean intradiscal pressure calculated from muscle strength was 802.9 N. The thoracolumbar three-dimensional trunk musculoskeletal model generated in the present study could potentially be used to analyze spinal moment and trunk muscle strength during static and dynamic motions

Reproducibility and Characteristics of Peak Cough Expiratory Flow

本研究の目的は,熱線式スパイロメータを用いて咳嗽時の最大呼気フロー(peak cough expiratory flow; 以下PCEF)の測定を行い,測定再現性について検討し,基本的属性,スパイロメトリー,呼気筋力との関連をみることでこのパラメータの特性を明らかにすることである.健常な男性学生18名を対象にスパイロメトリー,呼気筋力測定,咳嗽力測定を行った.PCEFの測定値のICC (1,1)は0.74であり,ICC(1,2)は0.85であった.咳嗽力と基本的属性,スパイロメトリー,呼気筋力との相関係数はr=-0.438〜0.456であり,統計学的有意には至らなかった.ステップワイズ法による重回帰分析では,PCEF=年齢×(-0.069)+身長×0.078-2.763の回帰式が得られた(p<0.05).以上より, PCEFで測定した咳嗽力は測定再現性があり,年齢と身長の影響を受ける可能性があることが示され,また,ピークフロー値をはじめとしたスパイロメトリーのパラメータ,呼気筋力と相関関係を認めないことから,他のパラメータとは独立した呼吸機能の指標であると考えられた.The purpose of this study was to examine the reproducibility of peak cough expiratory flow (PCEF) measured by thermal spirometer, and to clarify the characteristics through analysis of relationship between this parameter and the fundamental characteristics, spirometory data and expiratory muscle strength. The spirometer data, expiratory muscle strength and PCEF of eighteen male students of normal health were measured. The intraclass correlation coefficient (ICC) (1,1) of measured PCEF was 0.74 and ICC(1,2) was 0.85. The relationship between PCEF and fundamental characteristics, spirometory data and expiratory muscle strength was r=-0.438〜0.456, not statistically significant. The equation; PCEF=age× (-0.069)+height×0.078-2.763 was obtained by stepwise regression (p<0.05). In conclusion, it was shown that cough intensity measured as PCEF has measurement reproducibility, and there is a possible influence by age and height. Furthermore, since PCEF did not relate to spirometory data such as peak flow rate and expiratory muscle strength, cough intensity might be a specific parameter of respiratory function independent from other parameters

Lung metastasis from gastric cancer presenting as diffuse ground-glass opacities

Most metastatic lung tumors display well-defined, round, multiple nodular shadows, whereas the presence of diffuse ground-glass opacities on chest computed tomography generally suggests non-malignant conditions. Here, we report an unusual case of pulmonary metastasis from gastric cancer in which diffuse ground-glass opacities were observed in all lung segments. A 59-year-old man with a 3-month history of worsening chest pain and shortness of breath was referred to the pulmonary clinic. Chest computed tomography revealed low attenuation areas, suggesting emphysema, along with diffuse ground-glass opacities and interlobular septal thickening in both lungs. A transbronchial lung biopsy specimen revealed signet-ring cell carcinoma infiltrating the alveolar septa. Immunohistochemical staining of the cancer cells was positive for CDX-2, cytokeratin 7, and cytokeratin 20, and negative for surfactant apoprotein-A, TTF-1, and Napsin A. Gastrointestinal endoscopy revealed an ulcerative tumor in the stomach, and a biopsy from the tumor demonstrated malignant cells with similar morphology and immunophenotypes as those in the lungs. The final diagnosis was diffuse lung metastasis from gastric cancer. Our case shows that although multiple, well-defined nodules are typically considered to be the classic presentation of pulmonary metastasis, clinicians should also be aware of the possibility of pulmonary metastasis presenting as diffuse ground-glass opacities