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Background: Sarcopenia was initially recognized as a marker representing the nutritional condition or aging. Recently, sarcopenia has been associated with a poor prognosis and postoperative complications. We examined the importance of sarcopenia as a predictive marker of the prognosis in penile cancer. Materials and Methods: A total of 25 patients diagnosed with penile cancer who underwent penile resection from 2000 to 2010 were analyzed in this study. The psoas muscle index (PMI) was calculated based on psoas area using preoperative axial computed tomography images at the right L3 level divided by the square of the body height. Results: Nineteen (76.0%) patients underwent partial penectomy, and 6 (24.0%) underwent total penectomy. The median (mean ± standard deviation) age was 69.3 (69.0 ± 10.1) years old. Regarding the site of penile cancer, 17 (76.0%) cases were in the glans, 6 (24.0%) were in the foreskin, and 2 (8.0%) were in the shaft. Lymph node metastasis were seen in 6 cases (24.0%), and distant metastasis was seen in 1 case (4.0%). The lower PMI group (< 320.0) showed a significantly poorer progression-free survival than the higher PMI group (≥ 320.0) (p = 0.030), although no significant difference in the overall survival was noted (p = 0.076). Conclusions: Sarcopenia might be a useful prognostic factor in penile cancer patients.

We investigated time-dependent changes in the relapse features of renal cell carcinoma (RCC) after curative surgery. Between 1985 and 2015, 1398 patients with RCC (1226 clear cell RCC, 89 papillary RCC, and 53 chromophobe RCC) underwent curative surgery at Yokohama City University Hospital and its affiliated hospitals. We retrospectively reviewed the clinicopathologic factors of patients with relapse after surgery. Median follow-up was 56.3 months. Recurrence occurred in 245 patients (217 clear cell RCC, 12 papillary RCC, and 3 chromophobe RCC). Papillary RCC and chromophobe RCC had no recurrence beyond 5 years after surgery, but 20 cases of clear cell carcinoma had recurrence beyond 10 years after surgery. The typical recurrence sites of clear cell RCC were lung (46.6%), bone (17.9%), liver (7.6%), and lymph nodes (6.5%). The proportion of recurrences at these typical sites was 83.9% for recurrences within 5 years, 76.3% between 5 and 10 years, and 40.0% beyond 10 years. In contrast, the proportion of retroperitoneal organ recurrence, including contralateral kidney, pancreas, and adrenal glands, increased with increasing time after surgery. Interestingly, the hazard ratio of typical site relapse decreased whereas that of retroperitoneal organ relapse increased in a time-dependent manner. In summary, clear cell RCC showed potential to relapse beyond 10 years after surgery. Recurrence at typical sites decreased whereas retroperitoneal organ recurrence increased in a time-dependent manner. Clinicians should check for recurrence at various sites beyond 10 years, especially in clear cell RCC.

More accurate diagnostic procedures for prostate cancer are needed to avoid unnecessary biopsy due to the low specificity of prostate-specific antigen (PSA). Recent studies showed that the percentage of serum isoform [-2]proPSA (p2PSA) to free PSA (%p2PSA), the Prostate Health Index (PHI) and magnetic resonance imaging (MRI) were more accurate than PSA. The aim of this study was to test the accuracy of %p2PSA, PHI and MRI in discriminating patients with and without prostate cancer.The subjects were 50 consecutive men with a PSA level of 2.0-10.0 ng/ml, who underwent prostate biopsy from October 2012 to July 2014. These patients underwent multiparametric MRI before biopsy, and their serum samples were measured for PSA, free PSA and p2PSA. The sensitivity, specificity and accuracy of PHI, %p2PSA and MRI were compared with PSA in the diagnosis of biopsy-confirmed prostate cancer.In a univariate analysis, %p2PSA [area under the curve (AUC): 0.811] and PHI (AUC 0.795) were more accurate than MRI (AUC: 0.583) and PSA (AUC: 0.554) for prostate cancer detection. At 60% sensitivity, the specificity of PHI (76.5%) was higher than that of MRI (52.9%). For significant cancer detection, %p2PSA (AUC: 0.745), PHI (AUC: 0.791) and MRI (AUC: 0.739) were marginally more accurate than PSA (AUC: 0.696). At 85% sensitivity, the specificity of MRI (62.1%) was higher than that of PHI (34.5%).PHI and %p2PSA can be used for screening the general population and MRI can be used for detection of significant cancer in patients suspected, from screening tests, of having prostate cancer.

The statistical properties of the center of pressure (COP) change over time, and -invariant methods of the COP analysis is not sufficient to monitor the changes. Therefore, dynamic temporal information of the COP signals has been important in assessing the postural stability. The purpose of this study was to evaluate the characteristic pattern of time-frequency dynamics during the upright stance in patients with unilateral vestibular dysfunction (UVD). This study included 20 dizzy patients with UVD and age-matched 20 control subjects without any vestibular disorder. The COP signals were collected using a single standard force platform and a spectral analysis including the time-frequency dynamics was carried out on the basis of the maximum entropy method (MEM) by using a segment time series analysis. The power spectral density (PSD) analysis exhibited an exponential decreasing shape (1/f (-)(β)) when plotted on a double logarithmic scale. The average value of β in the low frequency range of less than 1 Hz in the UVD group was significantly lower than that in the control group (p < 0.05) in the medial-lateral (ML) direction under eyes closed condition. In the segment time series analysis, the peak frequency of the COP signals in the patients with UVD gradually converged to the frequency range of 0.1-0.2 Hz in the ML direction under EC condition. Our results suggest that the segment time series analysis of the COP signals can derive a characteristic pattern related to the UVD. It may indicate an increased reflexivity of the COP fluctuation by the UVD, resulting in inducing the instability.

Background The neutrophil-to-lymphocyte ratio (NLR), a simple marker of the systemic inflammatory response, has been demonstrated to correlate with patient outcomes for various solid malignancies. We investigated the utility of the pretreatment NLR as a prognosticator in patients who presented with penile cancer. Methods A total of 41 patients who underwent complete blood count with differential and subsequent radical penectomy from 1988 to 2014 were analyzed. We assessed the correlation between the NLR and the prognosis of penile cancer. Results The median and mean (± SD) NLRs in 41 penile cancer patients were 3.42 and 5.03 ± 4.99, respectively. Based on the area under receiver operator characteristic curve, the cut-off value of NLR was determined to be 2.82. Patients with a high NLR (≥2.82) showed a significantly poorer cancer-specific survival (p = 0.023) than those with a low NLR. Conclusions The pretreatment NLR may function as a biomarker that precisely predicts the prognosis in patients with penile cancer.

UNLABELLED In the present study, we investigated the body sway in patients with unilateral vestibular dysfunction by the largest Lyapunov exponents using a chaotic time series analysis. The largest Lyapunov exponent is regarded as a parameter indexing an orbital instability. MATERIALS AND METHODS Subjects consisted of 55 normal healthy subjects, 11 patients diagnosed as having vestibular neuritis (VN), 6 patients diagnosed as having sudden deafness (SD) with vertigo, 23 patients diagnosed as having Meniere disease (MD), 11 patients diagnosed as having benign paroxysmal positional vertigo (BPPV) and 14 patients diagnosed as having other vestibular disorders. Using a stabilometer, the sway of the body center of gravity in an upright standing position was recorded with eyes open and closed for 60 seconds under each condition. From the time series data obtained, the largest Lyapunov exponents were calculated using a chaos analysis program. RESULTS In normal healthy subjects and patients with unilateral vestibular dysfunction, the largest Lyapunov exponents on right-left sway were larger than those on forward-backward sway with eyes open and closed. The largest Lyapunov exponents in patients with unilateral vestibular dysfunction on forward-backward sway with eyes closed were significantly larger than those in normal healthy subjects. A few patients with the instability of standing posture judged from conventional analysis (area of sway, locus length per time) showed higher values of the LLE. We investigated the variation of the values of the largest Lyapunov exponents in patients with unilateral vestibular dysfunction at each stage during recovery from their vestibular damage. The largest Lyapunov exponents at the early stage with stable standing posture were significantly higher than those at the late stable stage with stable standing posture. Some patients at the very early stage had lower values of the largest Lyapunov exponents. CONCLUSION We speculate that the orbital instability indicated by the values of the largest Lyapunov exponents has a different significance from instability of standing posture indicated by a conventional analysis. We propose that the largest Lyapunov exponents may be an useful subsidiary measure to evaluate postural stability and its change due to vestibular dysfunction.

To investigate the relationship between white matter lesions identified on MRI and balance dysfunction in elderly persons, we evaluated findings on brain MRI and body sway examined with a stabilometer in persons (n=49) aged over 50 years old who were hospitalized for a thorough medical checkup. The total number and major axes of spots indicating deep white matter, hyperintense signals (DWMH) on MRI were measured. If the total number of spots exceeded 10 or the major axes exceeded 4 mm, white matter changes were judged to be severe. Sway of the body is center of gravity was recorded with eyes open and closed for 60 seconds using a stabilometer. The sway area and locus length, as well as left-right (X position) and forward-backward (Y position) deviation of the center of sway were measured. The measurements regarding these parameters were compared with standard values in healthy subjects. Persons with normal values in all 4 parameters (sway area and right-left deviation with eyes open and closed) were regarded as stable, and persons with values beyond the normal range were regarded as unstable. Elderly persons with severe white matter lesions on MRI identified on a thorough medical checkup were significantly unstable. We suggested that elderly persons with severe white matter lesions tended to exhibit postural abnormalities due to brain arteriolosclerosis.Tokita proposed the usefullness of stabilometry on health examination to check the health condition and detect any signs of Cerebrovascular disorders. We believe that our results also showed the utility of stabilometry in health examinations.

Standing posture regulation system is considered to be complex systems. Body sway appearing in standing posture was investigated from this point of view. The sway of the body center of the gravity in upright standing was recorded with eyes open and closed each 60 seconds using a stabilometer in 10 normal subjects. From time series data obtained, attractor (embedding dimension: 3), correlation dimension, Lyapunov exponent, Lyapunov spectrum and the largest Lyapunov exponent were calculated using a chaos analysis program.Correlation exponent was not saturated on an increase of embedding dimension (from 2 to 7). The result indicated that attractor did not have self-similarity. The result suggests that the irregular fluctuation observed in standing posture is not deterministic chaos.Lyapunov spectrum indicated that nature of attractor was torus and random. The result suggests that the sway appearing in standing posture is constructed from quasi-periodic and random movement.The largest Lyapunov exponent indicated that orbital instability is high in right-left sway than forward-backward sway. The control mechanism of standing posture differs in right-left and forward-backward directions.The analysis considering the complex systems provide information on postural control that cannot be obtained by conventional method.

White matter high intensity lesions on T2-weighted magnetic resonance imaging (MRI) are often detected in aged people. Arteriosclerosis appears to be the most important causative factor in the development of such high intensity signals, and the extent of white matter lesions is thought to reflect the extent of brain arteriosclerosis. We reported that elderly patients with dizziness, especially of central origin, showed significantly more severe white matter lesions. To investigate the relationship between these white matter lesions identified on magnetic resonance imaging and balance dysfunction in elderly patients, we evaluated findings on brain MRI and body sway examined by a stabilometer in patients with dizziness (n=79) aged over 60 years old. Deep white matter hyperintense signals (DWMH) and periventricular hyperintensity (PVH) on MRI was graded usig a qualitative rating scale (Fazekas et al.). Sway of the body's center of gravity was recorded with eyes open and closed for 60 seconds using a stabilometer. Sway area, locus length, and right-left (X position) and forward-backward (Y position) deviations of the center of sway were measured. The measurement values of these parameters were compared with standard values in healthy subjects. Patients with normal values in all 8 items were regarded as stable, and patients with values beyond the normal range were regarded as unstable. In patients with dizziness aged 60-79 years old, those with severe white matter lesions (grade 2-3) on MRI were signifi-cantly unstable. We suggested that elderly patients with severe white matter lesions tended to have postural abnormalities and show dysfunction of the central nervous system due to brain arteriolosclerosis.

Health examination using stabilometry was studied to check the health condition from the standpoint of body equilibrium.Using a stabilometer, sway of the center of gravity in upright standing was recorded with eyes open and closed for 60 seconds. The parameters measured were the area, locus length, right-left and forward-backward deviation of the center of sway, power spectrum, position and velocity vectors and standard deviation, skewness and kurtosis of amplitude histogram. Each measurement value was compared with standard values in healthy subjects and evaluated as stable (normal) or unstable (abnormal). The stabilometry was carried out in 1179 subjects of the ages 19-87.1. The relationship of the parameters measured to the detection rate of the abnormal indicated that stabilometry evaluating area and right-left deviation was suitable for health checkup.2. The number of subjects evaluated as abnormal in the stabilometry among care staff was significantly more than that among office staff.3. The number of subjects with hypertension, high arteriosclerosis index and low glucose tolerance in the abnormal group in the stabilometry was significantly more than that in the normal group.Stabilometry evaluating area and right-left deviation was useful for checking on health condition and detecting dangerous factors of cerebral vascular disorders.

In 1968, the Japan Society of Vestibular Research changed its name to Japan Society of Equilibrium Research (JSER) with the idea that vestibular function should be investigated from the point of view of body equilibrium in relation to visual and proprioceptive function.In the period from 1968-2000, progress in the following studies was noticed: (1) 3-dimensional recording of nystagmus and eye movements, (2) analysis of the body sway in upright standing posture, (3) examination of otolithic organ using vestibular evoked myogenic potential, linear acceleration and eccentric rotation test, (4) diagnosis, epidemiology and conservative and surgical treatment of Meniere disease, (5) diagnosis of vertigo and equilibrium examination using neuro-otological examination, computed tomography and magnetic resonance imaging, (6) training and rehabilitation for equilibrium disturbances, (7) localization and function of vestibular cortex, (8) eccentric rotation testing in the space shuttle.Currently, evidence-based medicine for vertigo, and regeneration of the sensory epithelium of the inner ear are new subjects in vestibular investigation.

In this study we classified stabilograms to elucidate the characteristics of sway in the body center of the gravity using principal component analysis and neural network (NN) in 826 healthy subjects.Stabilography was performed with eyes open and closed with both feet close together for 60 seconds using a stabilometer. The area, length/time, length/area, power spectrum, position and velocity vectors and standard deviation and kurtosis of amplitude histogram were measured. Principal component analysis and classification using NN were conducted using the measurement values.Principal components were calculated by 80% of the cumulative proportion, and 5 components were obtained. From the eigenvectors of the 5 components, 8 sway types were found and these were used to classify the sways of the 826 subjects. Learning by NN was carried out with measurement values obtained from the sways represented by each pattern, and a weighted NN was obtained with an error of 0.005. Stabilograms of healthy subjects were classified using the weighted NN into 9 sway types; large sway type, low frequency type, high frequency type, forward-backward enlargement type, right-left enlargement type, centripetal type, forward-backward sway type, right-left sway type, and non-specific type.We considered that the NN classification of stabilograms was useful for the observation of daily fluctuation of equilibrium function in healthy subjects.

Several stabilometric studies of the characteristics of labyrinthine equilibrium disturbance have been reported, but it is difficult to directly discriminate the degrees of labyrinthine damage and the stages of labyrinthine equilibrium disturbances (stages of disturbances, coordination and compensation) using stabilometric findings. The present study was designed to discriminate the degrees and stages of disturbance by neural network (NN) evaluation after learnings using measurement values of stabilograms from patients with labyrinthine disturbances. On stabilograms, envelope area, length/time, length/area, deviation on X-and Y-axes, and Romberg's coefficient were measured. Learning and evaluation by NN were performed using a program developed by Anima corporation. As the method of learning, we compiled a data file for learning and designated the composition of net, then practiced. As the method of evaluation, we compiled a data file for evaluation and evaluated the data by a weight file which was acquired in the process of learning. Learning and evaluation by NN were carried out using the following 2 supervised signals : (1) percent of canal paresis (CP%) obtained from caloric test. (2) stage of labyrinthine disturbance diagnosed by clinical findings.Results : (1) For discrimination of the degree of labyrinthine damage stabiometric results were noncontributory. (2) Stabilograms of patients with various stages of disturbances, coordination and compensation were discriminated with a square error of 0.06. The NN was useful for discriminating the stages of labyrinthine disturbances.

This study investigated the characteristics of postural sway in cases of Parkinson's diesease (PK). We examined 16 patients previously diagnosed with PK. The subjects stood on a stabilometer with their eyes open or closed, and the sway of the center of gravity of the body was recorded for one minute. The sway pattern during standing posture in PK patients was analyzed.The subjects consisted of 16 patients, including two with positive symptoms (PK-P), while six (PK-Na) and eight (PK-Nb) had negative symptoms.Results1) With eyes opened, the sway pattern was centripetal in six, right-left in two, diffuse in two, the displacement type in four and the multiple center type in two. With eyes closed, the sway pattern was centripetal in four, forward-backward in four, right-left in three, diffuse in one, the displacement type in two and the multiple center type in two. The displacement and multiple center types were representative of body sway in PK.2) Considering the similarities in body sway with eyes open and closed, we divided body sway in PK into three groups (centripetal and forward-backward type, right-left and diffuse type, displacement and multiple center type).3) Considering the relation between the classification by symptoms and body sway, we related PK-Na with displacement and multiple center type and PK-Nb with right-left and diffuse type.It was demonstrated that the centripetal and forward-backward type involved disorders in postural fixation and equilibrium, the right-left and diffuse type involved righting disorder, while the displacement and multiple center type involved tremor, akinesia and disorders in postural fixation and equilibrium.

This study investigated the characteristics of postural sway in cases of Parkinson' s disease (PK). We examined 16 patients diagnosed with PK, of whom 2 were classified as positive symptoms (PK-P), while 6 (PK-Na) and 8 (PK-Nb) were found to exhibit negative symptoms. The subjects stood on a stabilometer with their eyes open or closed with both foot closed together, and the sway of the center of gravity of the body was recorded for one minute. This paper presents 20 measurements of stabilometry in PK, comparing the mean ±2 SD classified by gender and age of healthy subjects, mean ±1 SD, and with observation of factor analysis.1) There were only a few cases demonstrating data exceeded the mean ±2 SD, considering each parameter. All cases of PK-Na and 6 of 8 PK-Nb cases exceeded the mean ±2 SD, considering every parameter.2) Four of 8 PK-Nb cases exceeded the mean ± 1 SD, for area, locus length, Romberg's coefficient, vector of velocity in the forward-backward and right-left and standard deviation of amplitude probability density distribution in X- and Y- axes considering each parameter. The proportion of patients exceeding the mean was higher in PK-Nb than in PK-Na.3) Factor 1 showed centripetal and forward-backward sway type with high factor loading as to locus length, high frequency band in X and Y, vector of velocity in the forward-backward and kurtosis of amplitude probability density distribution in Y. Factor 2 showed right-left and diffuse sway type with high factor loading as to area, vector of velocity in the right-left and standard deviation of amplitude probability density distribution in X and Y. Factor 3 showed displacement and multiple center type with high factor loading as to deviation of the center of sway in X and skewness of amplitude probability density distribution in X and Y.

This study investigated the characteristics of postural sway in cases of Parkinson's disease (PK). We previously reported sway patterns, its measurements, and factor analysis. This paper investigates learning and evaluation by neural networks.Each subject stood on a stabilometer with their eyes open or closed, and the sway of the center of gravity was recorded for one minute. The learning and evaluation was performed using a neural network program developed by Anima corporation. Input data were 6 units (measurements values related to area and length) in analysis A and 20 units (measurements values related to area and length, power spectrum, vector of velocity, amplitude probability density distribution curve) in analysis B. Output consisted of 3 units (positive, negative a, and negative b symptoms) in both analyses. There were 16 subjects, of whom 13 were used for learning and 3 for evaluation. Learning was carried out until the number of learning trials reached 10000, or the square error margin decreased to 0.005.Results1) In analysis A, learning revealed a square error margin of 0.005 after 690 trials, while the evaluations revealed a square error margin of 0.263.2) In analysis B, learning revealed a square error margin of 0.005 after 215 trials, while the evaluations revealed a square error margin of 0.267.Three symptoms were classified clearly as results of learning in analysis A and B. The number of learning trials in analysis B was less than that in analysis A, indicating that increased input resulted in fewer learning trials. The square error margin for evaluation was not good in either analysis.

The present paper investigated methods of discriminating stabilograms of healthy subjects from those of patients with labyrinthine and central disorders using a neural network (NN).Stabilometry was performed with eyes open and closed with both feet close together for 60 seconds using a stabilometer. From the stabilograms, area, locus length, deviations of the sway, Romberg ratio, power spectrum, position and velocity vectors, and amplitude probability density distribution were measured. Stabilograms were evaluated using a NN program produced by Anima corporation. Data file for learning was composed of healthy subjects and patients with various labyrinthine and central disorders. Data file for evaluation was composed of patients diagnosed with labyrinthine disorders.As a result of learning, stabilograms of healthy subjects and patients of labyrinthine and central disorders were clearly discriminated. The square error was 0.005. In evaluations using a NN weighted by learnig, the square error was 0.326.In medical examinations of patients with vertigo and equilibrium disturbances, discrimination of stabilograms is important for diagnosis of sites of lesion and classification of types and stages of disease. Learning and evaluation using a neural network are expected as a useful method for discriminating stabilograms. However, errors in evaluation (i.e. generalization error) remain high value. In the future, reducing generalization errors is a key issue.

This study attempted to discriminate stabilograms using a neural network that can learn with experience in patients with vertigo and equilibrium disturbances.Stabilograms obtained from 60 patients with disorders of the labyrinth, the cerebellum and the basal ganglia were used in this study. Area, length per second, length per unit area, displacements in X- and Y-axes and Romberg ratio of the stabilograms were used as input signals. The learning of the network was carried out with a specially designed program.1 Stabilograms of patients with disorders of the labyrinth and the central nervous system were discriminated with an square error margin of 3.36E-02.2 Stabilograms of patients with bleeding in the cerebellar vermis, bleeding or infarction of the cerebellar hemisphere and spinocerebellar degeneration were discreminated with an square error margin of 4.98E-03.3 Stabilograms of patients with positive phenomena, negative phenomena a and b in Parkinson disease were discriminated with an square error margin of 4.98E-03.Neural networks obtained from learning using stabilograms were useful for discrimination of lesion sites and pathophysiologies of various diseases.

Sway of the body's center of gravity (BCG) in an upright standing posture were studied during horizontal translation of the support surface using a specially designed stabilometer. The experiments were performed on 5 health subjects and 6 patients with unilateral labyrinthine disturbances. They stood on the support surface with their feet 10 cm apart, and the surface was moved at an amplitude of 10 cm at velocities of 2, 4, 6, 8 and 12cm/s, respectively. Backward, forward, rightward and leftward translation were examined with eyes open and closed. Under each test condition, one or three trials were performed. The superimposed and averaged results were displayed.Backward translation with 5 cm/s caused a forward displacement of the BCG with a latency of 20-30 ms (Responce 1, R1), a backward displacement with a latency of 30-45 ms after the onset of R1 (Responce 2, R2) and forward displacement with a large amplitude and a latency of 135-145 ms after R1 (Responce 3, R3) which indicated maximal displacement 145-255 ms after the onset of R3 (Responce 4, R4) and return to the original position before the onset of translation.Responses caused by forward, rightward and leftward translation were similar to the response of backward translation, except for R2 on right and left translation which provide unclear results.R2 and R3 were considered to be displacement due to spinal stretch reflex and dynamic labyrinthine reflex, respectively.Two patients with an intense decrease in caloric response in the affected labyrinth indicated a decrease in R3 induced by translation to the affected side.

A passive impulsive head rotation test was performed to evaluate the affected side of the labyrinth.A device reported by Tokita (1993) was used to record head and eye movements. Displacements and velocities of head and eye movements were respectively recorded by terrestrial magnetism sensor and an electronystagmographic technique. To examine vestibulo-ocular response (VOR), passive impulsive head rotations to the right and left at irregular intervals were performed repeatedly similar to the maneuver reported by Halmagyi et al (1993). From the record, latency and VOR gain ratio (VOR gain on the affected side rotation/VOR gain on the healthy side rotation) at 40ms and 80ms after onset of head rotation were measured.Twenty-two patients with unilateral vestibular disorders were examined in this manner. The affected side of the labyrinth was determined by caloric test.Seventeen patients showed VOR gain ratios less than 0.8 indicating hyporeaction of the affected labyrinth. Three patients including one with a slight canal paresis on caloric test showed ratios within 1±0.2. Two patients including one with a prolonged course showed ratios greater than 1.2. Examination of the VOR gain ratio on passive impulsive head rotation was a useful rotation test to evaluate the affected side of the labyrinth.

Stabilometry, a test to examine body balance in subjects standing upright, was evaluated for its significance in the focal diagnosis of vertigo and equilibrium disturbances.1. The pattern on X-Y recording of sway of the body center of gravity (statokinesigram) showed a right-left sway in unilateral labyrinthine disturbances, a forward-backward sway in bilateral labyrinthine disturbances and a diffuse sway in spino-cerebellar degeneration (cerebellar form). The type of the statokinesigram suggests the site of the lesion in patients with equilibrium disturbances.2. The area of the statokinsigram corresponded with the severity of vertigo and equilibrium disturbances. Measurement of the area was useful in following the course of the disease and in evaluating the effects of medical treatment and of equilibrium training.3. Determination of the locus length per unit area (L/A) was useful in evaluating the fine control of standing posture by spinal proprioceptive reflexes.4. Measurement of deviations of the center of body sway was useful in evaluating the severity of unilateral labyrinthine disturbances.5. The Romberg coefficient was useful in testing the visual control of standing posture and in detecting disorders of spinal afferents, such as the posterior funiculus and the spinocerebellar pathway, and of the labyrinth.For focal diagnosis in patients with equilibrium disturbances, it is important to evaluate the combined results of the above examinations.

The purpose of this study was to determine reference intervals of the characteristics of the visual-vestibuloocular reflex in healthy subjects.Head and eye movements during active head oscillation were examined. The head was oscillated in the horizontal (H) and vertical (V) planes, and head movements were recorded with a terrestrial magnetism sensor. Eye movements were recorded by an elec-tronystagmographic technique. The examination was performed under the following 2 conditions: a) visual fixation on an earth-fixed target in the light (test for visual-vestibuloocular reflex, VVOR), and b) image fixation on an earth-fixed target in the dark (test for vestibuloocular reflex, VOR). The data were stored on a floppy disc in a microcomputer. From the stored data, transfer function was calculated with head movements as input and eye movements as output in a specially designed program.Five healthy adults were tested. From the data obtained, the mean and the standard deviation were calculated.Resultsa) VVOR test:(1)The breakpoint frequencies were 3.3±0.5 Hz (H) and 2.2±0.4 Hz (V).(2)The frequency ranges of 180°±10° were 0.2±0.1-0.9±0.2 Hz (H) and 0.2±0.2-0.6±0.6 Hz (V).b) VOR test(1)The gains at 0.1 Hz were-5±2 dB (H) and-3±2 dB (V).(2)The slopes of the gain enhancement were 6±2 dB/dec (H) and 4 ± 4 dB/dec (V).(3)The frequency ranges of 180°±10° were 0.1±0.1-0.8±0.2 Hz (H) and 0.2±0.1-0.6±0.4 Hz (V).The mean±the standard deviation×2 are presented as reference intervals.

The purpose of this study is to make clear the significance of locus length per unit area (total locus length/ area of sway, L/A) as a parameter of stabilometry. We examined 100 healthy subjects aged 6 to 73 years. The subject stands on a stabilometer with eyes open or closed, and the sway of the center of gravity of the body is recorded for one minute. The pattern and area of sway, total locus length, L/A, Romberg's coefficient and power spectrum are recorded, and the L/A and other parameters are correlated.1) The L/A with eyes closed was low in those less than 20 years of age, higher at age 20 to 50. After age 60, these were some individual differences.2) The values of L/A with eyes closed were similar to those with eyes open.3) The L/A showed a negative correlation with the area of sway and the RMS.4) The L/A was not related to total locus length or Romberg's coefficient.5) Subjects with a high L/A had a high density power spectrum at 2-5 Hz.These findings show that L/A is a parameter of the fine control of standing posture by proprioceptive reflexes. The L/A is useful in the examination of the regulation of stan-ding posture.

This paper deals with an otitis media in children which was seen frequent in the Fukuchiyama region from 1951 to 1952. It was first reported by Dr. Yutaro Nishigaki in Fukuchiyama City and then observed by Dr. Masaich Takino of Gunze Hospital in Ayabe adjoining Fukuchiyama.We examined 65 patients at Dr. Nishigaki's request and carried out mastoid operations on 13 ears of 11 patients. The clinical features of the disease were similar to the otitis media which is now called otitis media with effusion (OME). The age of the patients, otoscopic appearance, operative and histopathologic findings and results of bacteriological and virological examinations are described on the basis of Asai's paper which was read at the Annual Meeting of the Otorhinolaryngological Society of Japan in 1953.In Japan, the incidence of OME has increased since the 1970's, and there are many clinical and etiological problems. We hope that the this information about numerous cases of OME in the early 1950's will provide significant insight into the pathogenesis of the disease.

To clarify the mechanism of the development of equilibrium skills, a study was done of subjects standing on a freely movable balance-board who practiced maintaining their balance while moving freely in a left-right direction. Swayings of the head and of the body's center of gravity (BCG), activities of both soleus muscles and the inclination of the balance-board before and after training were recorded with a polygraph and analyzed with the use of a 5-dimensional feedback model.We observed acquisition, maintenance and transfer gained by training. (1) Acquisition was manifested by the effects of training on four healthy adults using a balance-board for 30 minutes daily for two months. (2) Maintenance was mani-fested in two of the subjects by grades of acquisition after a rest period of a month. (3) Transfer was manifested by the effects of training in two separate healthy adults standing on one foot for 20 minutes daily for two months instead of using a balance-board.Results : (1) Acquisition training using a balance-board led to regular swayings of the head and BCG, and steady activities of both soleus muscles without burst discharge, with subsequent horizontal maintainability of the balance-board. Swa-yings of the head and BCG and muscle activity corresponded to the movement of the balance-board. Muscle activity, especially, showed high power and fine control up to a high frequency. (2) Maintenance acquired balance-board training effects were decreased, but maintained. (3) Transfer : the ability to maintain balance acquired by training in standing on one foot to some degree equalled that acquired by using a balance-board.We noted that maintenance of a steady standing posture was possible because labyrinthine and proprioceptive postural regulations became precise with pre-dominant improvement in spinal proprioceptive reflexes.

Two patients with upbeat nystagmus in the primary position of gaze were studied neuro-otologically. The nystagmus appeared with oscillopsia and body imbalance in gait and standing. These symptoms appeared during malnutrition caused by the loss of appetite. One patient was alcoholic and the other had a psychiatric disorder. Nutritional encephalopathy was diagnosed in both patients.1) Upbeat nystagmus was observed during forward, downward, right and left gaze. It did not behave in accordance with Alexander's law. Pursuit eye movement in the upward direction was saccadic, and the velocity of saccadic eye movement in the downward direction decreased. Vertical optokinetic nystagmus could not be elicited. Disturbance of horizontal eye movements was observed in pursuit eye movement and optokinetic nystagmus.2) The position and velocity of the head and eyes during vertical head oscillation with fixation on an earth-fixed visual target were recorded with a microcomputer and a specially designed program. The velocity of upward eye movements was faster than that of downward eye movements, suggesting a disturbance of the integration mechanism from position signal to velocity signal in visual and vestibular pursuit eye movement.We concluded that a disturbance of the neural integrator in the prepositus hypoglossi nuclei was probably responsible for upbeat nystagmus in these patients.

A new apparatus capable of recording head and eye movements was devised to examine the vestibulo-ocular system. Horizontal and vertical head movements were recorded with a sensor of terrestrial mgnetism. Eye movenments were recorded by an electronystagmographic technique. The transmitted data were stored on a floppy disc and analyzed with a microcomputer in a specially designed program.1. The apparatus was useful as a tool for recording spontaneous and gaze nystagmus and pursuit and saccadic eye movements in patients with labyrinthine and central disturbances.2. Transfer function (gain and phase) of the vestibulo-ocular system was calculated with head and eye movements obtained from pseudo-random head oscillation in the dark. In normal subjects, gain with head movements as input signal and eye movements as output signal indicated a frequency-dependent gain enhancement;the phase difference between head eye movements was 180°.3. The vestibulo-ocular reflex (VOR) induced by the right and left labyrinth were examined with velocity recording of head and eye movements induced by quick head movements to the right and left at intervals of 1 second in the dark. Patients with unilaterl labyrinthine disturbance showed a low amplitude response in head movements toward the affected labyrinth.4. The integration mechanism in the pursuit system was examined from the velocity recording of eye movements during vertical head oscillation with fixation on a visual target. A patient with primary position upbeat nystagmus caused by nutritional deficiency encephalopathy showed a disturbance of the up neural integrator from velocity signal to position signal in the visual vestibular oculomotor system.The apparatus was usuful for the examination of the vestibulo-ocular system of patients with vertigo and equilibrium disturbances.

Tests of visual fixation during head movements were evaluated.The subjects were asked to fix a visual target while the head was oscillated. Head and eye movements and the sum of both movements were recorded with a polygraph and stored in a microcomputer. From the stored data, transfer function was calculated with head movements as input and eye movements as output. As conditions of head movements, the following three head oscillations were studied. 1) "1 Hz method" in which the head was oscillated at 1 Hz ; 2) "acceleration-deceleration method", in which oscillation of the head started at 0.3 Hz, accelerated gradually until it was as rapid as possible, then decelerated gradually ; 3) "pseudo-random method", in which oscillation of the head was as random as possible.In the "acceleration-deceleration method", visual fixation ability at 0.3 to 5 Hz was examined and the frequency at which failure of visual fixation occurred was easily noted, since the change of the frequency of head oscillation was sequential. Transfer function obtained from the "acceleration-deceleration method" was similar to that obtained from the "pseudo-random method".These results indicate that the "acceleraion-deceleration method" is the best of the tests of visual fixation during head oscillation.

We tested the range of visual fixation during head oscillations in a group of normal subjects who were asked to fix a visual target during oscillation of the head in the horizontal and vertical directions. Head and eye movements and the sum of both movements were recorded with a polygraph and stored in a microcomputer. To detect head and eye movements, we used a specially designed photodetector and an electronystagmographic method respectively. From the stored data, transfer function was calculated with head movements as input and eye movements as output. The normal range was defined as the mean and the standard deviation of the results.Eleven healthy male and female adults were tested.(1)The normal range obtained from polygraph records was 3.6Hz in the horizontal direction and 2.2 Hz in the vertical direction.(2)The normal range obtained from transfer functions was 4-5Hz in both horizontal and vertical directions.

The mechanism of the development of equilibrium skills was studied in subjects standing on a balance-board, somersaulting during gymnastic exercises and performing ballet rotations.1. The ability to stand steadily on a freely movable balance-board was achieved after several days practice. The records of sways of the head and center of gravity of the body and activities of the nuchal and soleus muscles indicat that maintenance of a steady standing posture was possible because labyrinthine and proprioceptive postural regulations became precise. The training effect was due to facilitation of the postural reflexes through the brainstem and spinal cord.2. A somersault requires a chain of postural reflexes : visual fixation, labyrinthine righting reflex upon the head, and tonic neck reflex. We conclude that the basal ganglia and cerebellum play important roles in the formation of this chain of postural reflexes.3. Eye and head movements during ballet rotation with spotting technique were studied using a telemeter in a beginner and a trained dancer. During the trained subject's rotation, eye movements induced by optokinetic and la-byrinthine-ocular reflexes appeared to be under voluntary control. The ballet rotation was a movement that postural reflexes were inserted into a chain of voluntary movements carried out by a central program formed by training. The cereberal cortex was involved in this central programming. In the functional development of body equilibrium by training, the degree of participation of the central nervous system varied depending on kinds of exercises trained : the cerebral level in ballet rotation, the basal ganglia and cerebellum level in somersaults, and the brainstem and spinal cord level in standing posture.

The purpose of this study is to clarify the role of visual information in walking.The subject was requested to walk to a visual target placed 8 m away. The upward-downward, right-left, and forward-backward movements of the head and the activities of the soleus muscles were recorded by a pen osillograph with the aid of a five-channel telemeter. The subject was examined while walking with eyes open and closed, and while wearing horizontal vision reversing prisms (HRP).Nine normal adult subjects were tested.1 When walking with eyes open or closed, the gait was stable.2 When wearing HRP, the gait was unstable. Eight of the 9 subjects lost the goal and stopped walking. This suggests that left-right reversed vesion caused a marked gait disturbance.3 When walking repeatedly wearing HRP, 2 of the 6 examined had to stop because of disorientation and marked nausea. This suggests that confused visual information while walking caused vertigo and autonomic symptoms.4 When walking repeatedly HRP, 4 of the 6 subjects reached the goal without interruption. Their steps were greatly shortened, suggesting that information from exteroceptors and proprioceptors was useful in stabilization of the gait while wearing HRP.

Evoked electromyograms (EMGs) induced by galvanic stimulation of the labyrinth were examined in the muscles of the lower limbs. The labyrinthine-evoked EMGs appeared in the muscles of the femoral and gluteal regions and of the legs, and these muscle activities were changed by the head position in spite of the labyrinthine stimulation being the same. The vestibulo-spinal reflexes fulfil these functions in coordination with the neck proprioceptor.

To clarify the role of vestibular and proprioceptive reflexes in the regulation of the upright standing posture, we analysed with feedback models sways of the head and of the body's center of gravity (BCG) and the activity of the nuchal and soleus muscles.Seven healthy adults were asked to stand upright with eyes closed and feet together on a stabilometer. The forward-backward sways of the head and BCG and the activity of the nuchal and soleus muscles were recorded polygraphically. The head sway and the nuchal muscle activity (head-nuchal muscle system) were analysed with a 2-dimensional feedback model to study vestibulo-spinal postural regulation. The sway of BCG and the soleus muscle activity (BCG-soleus muscle system) were analysed with a 2-dimensional feedback model to study proprio-spinal postural regulation.1. The determinants of the noise correlation matrix in the head-nuchal muscle system and in the BCG-soleus muscle system were close to 1, indicating good feedback.2. The order. of the autoregressive process, i. e. the length of the past sway forming the present sway, was greater in the head-nuchal muscle system than in the BCG-soleus muscle system.3. The power spectrum showed a higher power in the frequency range in the BCG sway than in the head sway. The correlogram showed that the correlation ratio decreased more rapidly to the base line in the BCG sway than in the head sway. These results indicate that regulation of the standing posture by proprioceptive reflexes is more minute than that by labyrinthine reflexes.4. The impulse responses calculated with the head sway as output and the nuchal muscle activity as input were divergent in 4 subjects. The impulse responses calculated with the head sway as input and the nuchal muscle activity as output were convergent in all 7. On the other hand, the impulse responses calculated with the BCG sway as output and the soleus muscle activity as input and with the BCG sway as input and the soleus muscle activity as output were convergent in all 7. These results suggest that the BCG-soleus muscle system provides greater stability than the head-nuchal muscle system.

The labyrinthine-spinal reflexes are influenced by the inputs from the cervical and lumbal propriocepters. We studied the afferent route by the retrograde WGA-HRP method in cats. After the injection of WGA-HRP into either the dorsal or the ventral Deiters' nucleus, labeled neurons were investigated in the spinal cord, the cerebellum, the contralateral vestibular nucleus complex and the brain stem nucleus. In this paper, we report the results in the spinal cord of cats. i) When WGA-HRP was injected into the dorsal Deiters' nucleus, labeled neurons in the spinal cord were found mainly extending from the cervical to the lumbosacral area of the spinal cord. A number of labeled cells were located predominantly in the contralateral cervical segments, while a small number of labeled cells was found ipsilaterally in the lumbosacral segments. ii) In the case of the ventral Deiters' nucleus, labeled neurons were found extending from the cervical to the upper thoracic area of the spinal cord. Localization of labeled neurons in the spinal cord was limited mainly to Rexed's laminae VII and VIII. These results suggest that the afferent fibers from the spinal cord to the Deiters' nucleus are closely related to the labyrinthine-spinal reflex.