Σάββατο 23 Απριλίου 2016
Identification of Infants at High Familiar Risk for Language-Learning Disorders (LLD) by Combining Machine Learning Techniques with EEG-based Brain Network Metrics
The population of children with language-learning disorders (LLD) is heterogeneous with a mixture of language deficits and also sensorimotor deficits linked to dynamic processing of the speech information (Catts et al., 2002). The core of research focused mainly on the hypothesis of whether deficits on auditory spectro-temporal processing can cause phonological impairment that potentially can lead to reading and language disorders (Bishop and Snowling, 2004). To answer the aforementioned questions, neuroscientists performed longitudinal studies of infants at genetic risk using neuroimaging methods and experimental protocols with main scope to understand the effects of auditory information to the development of language skills (Leppanen et al., 2002; Lyytinen et al., 2004).
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Effect of prefrontal and parietal tDCS on learning and recognition of verbal and non-verbal material
Stimuli presented in immediate succession during learning (massed repetition) are less well retained in memory than stimuli repeated after a delay (spaced repetition) (Nielsen-Bohlman and Knight, 1994; Chao et al., 1995; Kim et al., 2001, 2008). This effect is referred to as the spacing effect (Ebbinghaus, 1885/1992). Spacing effects have been reported with verbal and non-verbal and with meaningful and meaningless material (Challis, 1993; Mammarella et al., 2002; Russo and Mammarella, 2002; Russo et al., 2002).
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Similarities and differences among eosinophilic esophagitis, proton-pump inhibitor-responsive esophageal eosinophilia, and reflux esophagitis: comparisons of clinical, endoscopic, and histopathological findings in Japanese patients
Abstract
Background
Esophageal eosinophilia is classified as either eosinophilic esophagitis (EoE) or proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE), depending on the response to PPI treatment. The aim of this study was to compare the clinical, endoscopic, and histopathological findings of EoE and PPI-REE in Japanese patients. In addition, the characteristics of these cases were compared with those of reflux esophagitis (RE) cases.
Methods
Eleven patients diagnosed with EoE, 16 with PPI-REE, and 39 with RE, who were all consecutively examined from 2005 to 2015 at Shimane University Hospital, were enrolled. Clinical, endoscopic, and histopathological esophageal findings in these groups were retrospectively examined and compared.
Results
The differences in the clinical characteristics of EoE and PPI-REE were not remarkable, though patients with EoE and PPI-REE were younger, presented a higher prevalence of allergic comorbidities, and complained of symptoms of dysphagia more frequently than those with RE. The only noteworthy differences between EoE and PPI-REE were more frequent reports of asthma (36.4 vs. 2.6 %) and food allergy (27.3 vs. 0 %) by patients with EoE (P < 0.05, P < 0.05, respectively). Endoscopic findings in patients with EoE and PPI-REE were similar, with the presence of esophageal erosions in a small percentage of PPI-REE cases being the only difference. There were no histopathological differences between EoE and PPI-REE.
Conclusions
Comparisons of clinical, endoscopic, and histopathological findings between EoE and PPI-REE showed that these two types have similar characteristics, though EoE patients showed a higher atopic background. Predicting PPI responsiveness in cases with esophageal eosinophilia is difficult and requires further investigation.
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Stem cell dynamics and pretumor progression in the intestinal tract
Abstract
Colorectal carcinogenesis is a process that follows a stepwise cascade that goes from the normal to an invisible pretumor stage ultimately leading to grossly visible tumor progression. During pretumor progression, an increasing accumulation of genetic alterations occurs, by definition without visible manifestations. It is generally thought that stem cells in the crypt base are responsible for this initiation of colorectal cancer progression because they are the origin of the differentiated epithelial cells that occupy the crypt. Furthermore, they are characterized by a long life span that enables them to acquire these cumulative mutations. Recent studies visualized the dynamics of stem cells both in vitro and in vivo. Translating this work into clinical applications will contribute to the evaluation of patients' predisposition for colorectal carcinogenesis and may help in the design of preventive measures for high-risk groups. In this review, we outline the progress made in the research into tracing stem cell dynamics. Further, we highlight the importance and potential clinical value of tracing stem cell dynamics in pretumor progression.
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Cloning and expression analysis of c-type and g-type lysozymes in yellow catfish ( Pelteobagrus fulvidraco )
Abstract
Lysozymes have important roles in innate immune system. Here, a c-type and a g-type lysozyme were identified from yellow catfish (Pelteobagrus fulvidraco). The deduced amino acid sequences of both lysozymes were conserved in catalytic sites and structural features as compared to their counterparts from other species. It was interesting that the g-type lysozyme possessed a signal peptide. The c-type and g-type lysozymes had the highest identity 89.4 and 76.2 % with that from channel catfish respectively. Phylogenetic analysis showed that the two lysozymes had a closely relationship with that from channel catfish and Astyanax mexicanus. Lysozymes from one order could form more than one clade in the phylogenetic tree, which indicated the gene duplications in evolution. Expression analysis with real time quantitative PCR revealed that the two lysozyme genes were constitutively expressed in all the tested tissues. The highest expression of c-type lysozyme was observed in liver, followed by spleen, head kidney, and trunk kidney, while the g-type lysozyme had highest expression in intestine, followed by spleen, head kidney, and trunk kidney. The mRNA levels of both genes were all up-regulated after challenging with Aeromonas hydrophila. However, there were differences in tissues and time points when the mRNA levels reached its peak between the two lysozymes. It indicated the diversity in regulation mechanisms and detailed functions among lysozymes. Taking together, these results will benefit the understanding of yellow catfish lysozymes.
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Effect of temporal predictability on exogenous attentional modulation of feedforward processing in the striate cortex
Source:International Journal of Psychophysiology
Author(s): Tharaka L. Dassanayake, Patricia T. Michie, Ross Fulham
Non-informative peripheral visual cues facilitate extrastriate processing of targets [as indexed by enhanced amplitude of contralateral P1 event-related potential (ERP) component] presented at the cued location as opposed to those presented at uncued locations, at short cue-target stimulus onset asynchrony (SOA). Recently, two lines of research are emerging to suggest that the locus of attentional modulation is flexible and depends on 1) perceptual load and 2) temporal predictability of visual stimuli. We aimed to examine the effect of temporal predictability on attentional modulation of feed-forward activation of the striate cortex (as indexed by the C1 ERP component) by high-perceptual-load (HPL) stimuli. We conducted two ERP experiments where exogenously-cued HPL targets were presented under two temporal predictability conditions. In Experiment 1 [high-temporal-predictability (HTP) condition], 17 healthy subjects (age 18–26years) performed a line-orientation discrimination task on HPL targets presented in the periphery of the left upper or diagonally opposite right lower visual field, validly or invalidly cued by peripheral cues. SOA was fixed at 160ms. In Experiment 2 [low-temporal-predictability (LTP) condition], (n=10, age 19–36years) we retained HPL stimuli but randomly intermixed short-SOA trials with long-SOA (1000ms) trials in the task-blocks. In Experiment 1 and the short-SOA condition of the Experiment 2, validly-cued targets elicited significantly faster reaction times and larger contralateral P1, consistent with previous literature. A significant attentional enhancement of C1 amplitude was also observed in the HTP, but not LTP condition. The findings suggest that exogenous visual attention can facilitate the earliest stage of cortical processing under HTP conditions.
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Diaphragmatic herniation following esophagogastric resectional surgery: an increasing problem with minimally invasive techniques?
Abstract
Background
Post-operative diaphragmatic hernias (PODHs) are serious complications following esophagectomy or total gastrectomy. The aim of this study was to describe and compare the incidence of PODHs at a high volume center over time and analyze the outcomes of patients who develop a PODH.
Methods
A prospective database of all resectional esophagogastric operations performed for cancer between January 2001 and December 2015 was analyzed. Patients diagnosed with PODH were identified and data extracted regarding demographics, details of initial resection, pathology, PODH symptoms, diagnosis and treatment.
Results
Out of 631 patients who had hiatal dissection for malignancy, 35 patients developed of PODH (5.5 % overall incidence). Median age was 66 (range 23–87) years. The incidence of PODH in each operation type was: 2 % (4/221) following an open 2 or 3 stage esophagectomy, 10 % (22/212) following laparoscopic hybrid esophagectomy, 7 % (5/73) following MIO, and 3 % (4/125) following total gastrectomy. The majority of patients had colon or small bowel in a left-sided hernia. Of the 35 patients who developed a PODH, 20 (57 %) patients required emergency surgery, whereas 15 (43 %) had non-urgent repair. The majority of the patients had had suture repair (n = 24) or mesh repair (n = 7) of the diaphragmatic defect. Four patients were treated non-operatively. In hospital post-operative mortality was 20 % (4/20) in the emergency group and 0 % (0/15) in the elective group. Further hernia recurrence affected seven patients (n = 7/27, 26 %) and 4 of these patients (15 %) presented with multiple recurrences.
Conclusion
PODH is a common complication following hybrid esophagectomy and MIO. Given the high mortality from emergency repair, careful thought is needed to identify surgical techniques to prevent PODH forming when minimal access esophagectomy are performed. Upper GI surgeons need to have a low index of suspicion to investigate and treat patients for this complication.
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Impact of intraoperative cholangiography on postoperative morbidity and readmission: analysis of the NSQIP database
Abstract
Background
The debate regarding the merits of routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) continues to rage. We aim to analyze the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patterns of utilization of cholangiography during LC as well as its impact on patient outcomes.
Study design
This is a retrospective cohort study of patients undergoing LC with or without IOC in the 2012 and 2013 ACS NSQIP database. Only patients without any preoperative biochemical evidence of the CBD stone were included in the analysis. Comparison between two groups and data analysis focused on the following primary outcomes: 30-day mortality, readmission, return to operating room and NSQIP collected morbidity.
Results
Twenty-one percentage of patients undergoing LC without any biochemical abnormality are undergoing IOC. There were no statistically significant differences in thirty-day outcomes between two patient populations with regard to mortality, morbidity, cardiac, central nervous system, wound, deep vein thrombosis, sepsis, respiratory and urinary tract complications. Patients undergoing LC plus IOC were found to have statistically significant reduction in the rate of readmission related to the first operation (adjusted odds ratio 0.80, 95 % CI 0.70–0.92; P value = 0.002). Readmissions related to biliary complications including retained CBD following cholecystectomy were 1.61 times more likely in patients who underwent LC without cholangiography.
Conclusion
The use of IOC at the time of LC appears to be associated with a statistically significant decrease in re-admission rates, especially readmissions related to biliary complications.
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Does Low Threshold Value Use Improve Proximal Neoplasia Detection by Fecal Immunochemical Test?
Abstract
Background
Several studies have reported that the fecal immunochemical test (FIT) less sensitively detects proximal advanced neoplasia (AN) compared to distal AN. Low threshold value use may improve proximal AN detection.
Aim
To investigate whether FIT diagnostic accuracy for AN is different according to AN location and to compare FIT accuracy in proximal AN detection using different threshold values.
Methods
This retrospective study was conducted in a university hospital in Korea from June 2013 to May 2015. Out of 34,547 participants who underwent FITs, 3990 subjects aged ≥50 years who also underwent colonoscopies were analyzed. The FIT diagnostic accuracy for AN with differing locations (proximal vs. distal) and threshold values (20, 15, and 10 mcg Hb/g feces) were assessed.
Results
The sensitivity, specificity, positive predictive value, and negative predictive value of FIT in AN detection were 42.2, 84.3, 24.1, and 92.5 %, respectively. The FIT sensitivity for proximal AN detection was significantly lower than that for distal AN detection (32.7 and 49.0 %, respectively; P = 0.001). Lowering FIT threshold values tended to increase the sensitivity for proximal AN, whereas it significantly decreased the specificity for proximal AN. As a result, there was no significant difference in the accuracy for proximal AN detection (80.1, 79.3, and 78.1 % for 20, 15, and 10 mcg Hb/g feces, respectively; P = 0.107).
Conclusions
FIT was less sensitive in proximal AN detection than distal AN detection. Lowering the FIT cutoff threshold did not increase the accuracy for proximal AN detection. New biomarker development for colorectal cancer screening is required to improve proximal ACRN diagnostic accuracy.
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Laparoscopic incisional hernia repair after colorectal surgery. Is it possible to maintain a mini-invasive approach?
Abstract
Several benefits have been described in laparoscopic surgery. However, there is a lack of evidence concerning laparoscopic repair of incisional hernia after laparoscopic colorectal surgery (LCRS). We aimed to evaluate the feasibility and the results of laparoscopic incisional hernia repair after LCRS. Between May 2001 and March 2014, all charts of consecutive patients who underwent LCRS and developed an incisional hernia were evaluated. Patients with parastomal hernias or those with less than 6 months of follow-up were excluded. Patients were assigned to laparoscopic repair group (LR) and open repair group (OR). Demographics, surgical factors, and 30-day postoperative complications were analyzed. The incisional ventral hernia rate was 7 % (90/1290), and 82 incisional hernia repairs were performed. In 49 patients (60 %) an open approach was performed, and there were 33 laparoscopic repairs (2 converted due to small bowel injury). Mean age was 62 years. Average body mass index was 27.4 ± 5.2 kg/m2. The mean defect size was 56 (4–527) cm2, and there were no differences between the groups (LR: 49 cm2 vs OR: 63 cm2; p = NS). Average operative time was 107 (45–240) minutes (LR: 93 min vs OR: 116 min, p = 0.02). OR showed a higher rate of postoperative complications (OR: 51 % vs LR: 18 %, p = 0.003) and increased hospital stay (OR: 2.77 ± 4 days vs LR: 0.7 ± 0.4 days; p = 0.02). The recurrence rate was 15 % (12 patients, 6 each group; p = NS) after a follow-up of 48 (r: 6–141) months. Laparoscopic approach for incisional hernia repair after LCRS seems to be safe and feasible. Patients who received laparoscopic approach showed significantly less postoperative complications and shorter hospital staying. These observations suggest that mini-invasive surgery may be the initial approach in patients who develop an incisional hernia after LCRS.
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A bi-articular model for scapular-humeral rhythm reconstruction through data from wearable sensors
Patient-specific performance assessment of arm movements in daily life activities is fundamental for neurological rehabilitation therapy. In most applications, the shoulder movement is simplified through a soc...
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RNA-Seq Reveals Common and Unique PXR- and CAR-target Gene Signatures in the Mouse Liver Transcriptome
Publication date: Available online 23 April 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Julia Yue Cui, Curtis D. Klaassen
The pregnane X receptor (PXR) and constitutive androstane receptor (CAR) are well-known xenobiotic-sensing nuclear receptors with overlapping functions. However, there lacks a quantitative characterization to distinguish between the PXR and CAR target genes and signaling pathways in liver. The present study performed a transcriptomic comparison of the PXR- and CAR-targets using RNA-Seq in livers of adult wild-type mice that were treated with the prototypical PXR ligand PCN (200mg/kg, i.p. once daily for 4days in corn oil) or the prototypical CAR ligand TCPOBOP (3mg/kg, i.p., once daily for 4days in corn oil). At the given doses, TCPOBOP differentially regulated many more genes (2125) than PCN (212), and 147 of the same genes were differentially regulated by both chemicals. As expected, the top pathways differentially regulated by both PCN and TCPOBOP were involved in xenobiotic metabolism, and they also up-regulated genes involved in retinoid metabolism, but down-regulated genes involved in inflammation and iron homeostasis. Regarding unique pathways, PXR activation appeared to overlap with the aryl hydrocarbon receptor signaling, whereas CAR activation appeared to overlap with the farnesoid X receptor signaling, acute-phase response, and mitochondrial dysfunction. The mRNAs of differentially regulated drug-processing genes (DPGs) partitioned into three patterns, namely TCPOBOP-induced, PCN-induced, as well as TCPOBOP-suppressed gene clusters. The cumulative mRNAs of the differentially regulated drug-processing genes (DPGs), phase-I and –II enzymes, as well as efflux transporters were all up-regulated by both PCN and TCPOBOPOP, whereas the cumulative mRNAs of the uptake transporters were down-regulated only by TCPOBOP. The absolute mRNA abundance in control and receptor-activated conditions was examined in each DPG category to predict the contribution of specific DPG genes in the PXR/CAR-mediated pharmacokinetic responses. The preferable differential regulation by TCPOBOP in the entire hepatic transcriptome correlated with a marked change in the expression of many DNA and histone epigenetic modifiers. In conclusion, the present study has revealed known and novel, as well as common and unique targets of PXR and CAR in mouse liver following pharmacological activation using their prototypical ligands. Results from this study will further support the role of these receptors in regulating the homeostasis of xenobiotic and intermediary metabolism in liver, and aid in distinguishing between PXR and CAR signaling at various physiological and pathophysiological conditions.
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Enteric glia: the most alimentary of all glia
Abstract
Glia (from Greek γλοία meaning "glue") pertains to non-neuronal cells in the central (CNS) and peripheral nervous system (PNS) that nourish neurons and maintain homeostasis. In addition, glia are now increasingly appreciated as active regulators of numerous physiological processes initially considered exclusively under neuronal regulation. For instance, enteric glia, a collection of glial cells residing within the walls of the intestinal tract, regulate intestinal motility; a well-characterized reflex controlled by enteric neurons. Enteric glia also interact with various non-neuronal cell types in the gut wall such as enterocytes, enteroendocrine and immune cells and are therefore emerging as important local regulators of diverse gut functions. The intricate molecular mechanisms that govern glia-mediated regulation are beginning to be discovered but much remains unknown about the functions of enteric glia in health and disease. Here we present a current view of the enteric glia and their regulatory roles in gastrointestinal (GI) (patho)physiology; from GI motility and epithelial barrier function to enteric neuroinflammation.
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Phrenic motor outputs in response to bronchopulmonary C-fibre activation following chronic cervical spinal cord injury
Cervical spinal injury interrupts bulbospinal pathways and results in cessation of phrenic bursting ipsilateral to the lesion. The ipsilateral phrenic activity can partially recover over weeks to months post-injury due to the activation of latent crossed spinal pathways and exhibits a greater capacity to increase activity during respiratory challenges than the contralateral phrenic nerve. However, whether the bilateral phrenic nerves demonstrate differential responses to respiratory inhibitory inputs is unclear. Accordingly, the present study examined bilateral phrenic bursting in response to capsaicin-induced pulmonary chemoreflexes, a robust respiratory inhibitory stimulus. Bilateral phrenic nerve activity was recorded in anaesthetized and mechanically ventilated adult rats at 8–9 weeks post-C2 hemisection (C2Hx) or C2 laminectomy. Intra-jugular capsaicin (1.5 μg kg-1) injection was performed to activate the bronchopulmonary C-fibres to evoke pulmonary chemoreflexes. The present results indicate that capsaicin-induced prolongation of expiratory duration was significantly attenuated in C2Hx animals. However, ipsilateral phrenic activity was robustly reduced after capsaicin treatment compared to uninjured animals. Single phrenic fibre recording experiments demonstrated that C2Hx animals had a higher proportion of late-inspiratory phrenic motoneurons that were relatively sensitive to capsaicin treatment compared to early-inspiratory phrenic motoneurons. Moreover, late-inspiratory phrenic motoneurons in C2Hx animals had a weaker discharge frequency and slower recovery time compared to uninjured animals. These results suggest bilateral phrenic nerves differentially respond to bronchopulmonary C-fibre activation following unilateral cervical hemisection, and the severe inhibition of phrenic bursting is due to a shift in the discharge pattern of phrenic motoneurons.
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Does rapid and physiological astrocyte-neuron signalling amplify epileptic activity?
Abstract
The hippocampus is a key brain region in the pathophysiology of mesial temporal lobe epilepsy. Long-term changes of its architecture and function on the network and cellular level are well documented in epilepsy. Astrocytes can control many aspects of neuronal function and their long-term alterations over weeks, months and years play an important role in epilepsy. However, a pathophysiological transformation of astrocytes does not seem to be required for astrocytes to contribute to epileptic activity. Some of the properties of physiological astrocyte-neuron communication could allow these cells to exacerbate or synchronize neuronal firing on shorter timescales of milliseconds to minutes. Therefore, these astrocyte-neuron interactions are increasingly recognized as potential contributors to epileptic activity. Fast and reciprocal communication between astrocytes and neurons is enabled by a diverse set of mechanisms that could both amplify and counteract epileptic activity. They may thus promote or cause development of epileptic activity or inhibit it. Mechanisms of astrocyte-neuron interactions that can quickly increase network excitability involve, for example, astrocyte Ca2+ and Na+ signalling, K+ buffering, gap junction coupling and metabolism. However, rapid changes of astrocyte neurotransmitter uptake and morphology may also underlie or support development of network hyperexcitability. The temporal characteristics of these interactions, their ability to synchronize neuronal activity and their net effect on network activity will determine their contribution to the emergence or maintenance of epileptic activity.
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Safety and efficacy of sorafenib in Japanese patients with hepatocellular carcinoma in clinical practice: a subgroup analysis of GIDEON
Abstract
Background
GIDEON was a prospective, global, non-interventional study evaluating the safety of sorafenib in patients with unresectable hepatocellular carcinoma in real-world practice. The aim of this subgroup analysis was to assess the safety and efficacy of sorafenib as used by Japanese patients.
Methods
In Japan, 508 patients were valid for safety analysis. Efficacy and safety were evaluated by the Child-Pugh score.
Results
The number of patients with Child-Pugh A and B was 432 (85.0 %) and 58 (11.4 %), respectively. The median overall survival time and time to progression in patients with Child-Pugh A and Child-Pugh B were 17.4 and 4.9 months, 3.7 and 2.3 months, respectively. The most common drug-related adverse events (AEs) included hand-foot skin reaction (47.8 %), diarrhea (35.8 %) and hypertension (24.2 %). The incidences of all or drug-related AEs were similar between patients with Child-Pugh A and B. However, all or drug-related serious AEs, AEs resulting in permanent discontinuation of sorafenib and deaths were observed more frequently in patients with Child-Pugh B compared with Child-Pugh A. Duration of treatment tended to be shorter as the Child-Pugh score worsened.
Conclusions
Sorafenib was well tolerated by Japanese HCC patients in clinical settings. Patients with Child-Pugh B had shorter duration of treatment and higher incidence of SAEs. It is important to carefully evaluate patients' conditions and assess the benefit and risk before making a decision to treat patients with sorafenib.
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Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States, 1972-2014
Publication date: Available online 22 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yuying Chen, Yin He, Michael J. DeVivo
ObjectiveDocument trends in demographic and injury profile of new spinal cord injury (SCI) over time.DesignCross-sectional analysis of longitudinal data by injury years (1972–1979, 1980–1989, 1990–1999, 2000–2009, and 2010-2014)Setting28 SCI Model Systems centers throughout the United StatesParticipants30,881 persons with traumatic SCI enrolled in the National SCI DatabaseInterventionsNot applicable.Main Outcome MeasuresAge, sex, race, education level, employment, marital status, etiology, and severity of injuryResultsAge at injury has increased from 28.7 years in the 1970s to 42.2 years during 2010-2014. This aging phenomenon was noted for both sexes, all races, and all etiologies except acts of violence. The percentage of racial minorities expanded continuously over the last 5 decades. Virtually among all age groups, the average education levels and percentage of single/never married status has increased, which is similar to the trends noted in the general population. Although vehicular crashes continue to be the leading cause of SCI overall, the percentage has declined from 47.0% in the 1970s to 38.1% during 2010-2014. Injuries due to falls have increased over time particularly among those aged 46 years and older. Progressive increases in the percentages of high cervical and motor incomplete injuries were noted for various age, sex, race, and etiology groups.ConclusionsStudy findings call for geriatrics expertise and intercultural competency of clinical team in the acute and rehabilitation care for SCI. This study also highlights the need for a multi-dimensional risk assessment and multi-factorial intervention, especially to reduce falls and SCI in older adults.
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Quantifying change during outpatient stroke rehabilitation: A retrospective regression analysis
Publication date: Available online 22 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Keith Lohse, Marghuretta D. Bland, Catherine E. Lang
ObjectiveTo examine change and individual trajectories for balance, upper extremity motor capacity, and mobility in people post-stroke during the time they received outpatient therapies.DesignRetrospective analyses of an observational cohort using hierarchical linear modeling.SettingOutpatient rehabilitationParticipants366 persons post strokeInterventionsUsual outpatient physical and occupational therapyMain OutcomesBerg Balance Scale (BBS), Action Research Arm Test (ARAT), and walking speed were used to assess the 3 domains. Initial scores at the start of outpatient therapy (intercepts), rate of change during outpatient therapy (slopes), and the covariance between slopes and intercepts were modeled as random-effects. Additional variables modeled as fixed effects were: Duration (months of outpatient therapy), Time (days post-stroke), Age (years), and Inpatient status (if the patient went to an inpatient rehabilitation facility (IRF)).ResultsA patient with average Age and Time started at 37 points on the BBS with a change of +1.8 points per month, at 35 points on the ARAT with a change of +2.0 points per month, and with a walking speed of 0.59 m/s with a change of +0.09 m/s per month. When controlling for other variables, patients started with lower scores on the BBS and ARAT or had slower walking speeds at admission if they started outpatient therapy later than average or went to an IRF.ConclusionsPatients generally improved over the course of outpatient therapy, but there was considerable variability in individual trajectories. Average rates of change across all three domains were small.
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Risk Factors Associated with Neurogenic Bowel Complications and Dysfunction in Spinal Cord Injury
Publication date: Available online 22 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Denise G. Tate, Martin Forchheimer, Gianna Rodriguez, Anthony Chiodo, Anne Pelletier Cameron, Michelle Meade, Andrei Krassioukov
ObjectiveThe objectives of this paper are: 1) to assess the factors associated with methods of bowel management and bowel related complications and; 2) to determine the risk factors that are associated with bowel complications and overall bowel dysfunction, using multivariate modeling.DesignCross-sectional observational study.SettingA Spinal Cord Injury Model System located in upper East Midwest region of the United States with additional participants recruited from other sites.Participants291 subjects who incurred traumatic SCI with resultant neurogenic bowel who were at least five years post-injury at the time of interview.InterventionsNot applicable.Main Outcome MeasuresConstipation, Bowel Incontinence and Neurogenic Bowel Dysfunction questionnaire scores. These measures were all derived from the Bowel and Bladder Treatment Index. Data analyses included descriptive and bivariate statistics as well as logistic and linear regression modeling.ResultsRisk factors contributing to bowel incontinence included overall bowel dysfunction as measured by the Neurogenic Bowel Dysfunction score, timing of bowel program, being married or having a significant other, urinary incontinence, constipation, and use of diuretics. Constipation was best predicted by age, race/ethnicity, using laxatives/oral medications, incomplete tetraplegia, frequency of bowel movements, abdominal pain, access to clinicians and caregivers and history of bowel surgeries. Neurogenic Bowel Dysfunction scores were predicted by neurological classification, use of laxatives and/or oral medications, bowel incontinence, and frequency of fiber intake.ConclusionsThese results suggest a number of factors that should be considered when treating neurogenic bowel complications and dysfunction in persons with SCI.
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Objective and self-reported physical activity measures and their association with depression and satisfaction with life in persons with spinal cord injury
Publication date: Available online 22 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sara J. Mulroy, Patricia E. Hatchett, Valerie J. Eberly, Lisa Lighthall Haubert, Sandy Conners, JoAnne Gronley, Eric Garshick, Philip S. Requejo
ObjectiveTo identify associations between objective and self-reported measures of physical activity (PA) and relationships with depression and satisfaction with life (SWL) in persons with spinal cord injury (SCI).DesignRetrospective, cross-sectional study of objectively measured wheelchair propulsion (WCP) from two studies in which an odometer was attached to participants' wheelchairs to record daily speed and distance. Self-reported data was collected in a separate study examining dyspnea, PA, mood, and SWL.SettingOut-patient clinic in a rehabilitation center.Participants86 individuals with traumatic SCI who use a manual wheelchair.InterventionsNot applicable.Main Outcome Measure(s)Objective measures of PA included average daily distance and speed of WCP measured by an odometer. Self-report questionnaires included demographics, the 24-hour recall of transfers, Physical Activity Recall Assessment for People with SCI, the Patient Health Questionnaire (PHQ-2) to document depressive symptoms, and the Satisfaction with Life Scale (SWLS).ResultsBoth objective measures of WCP, average daily distance and speed, were predicted by the combination of self-reported daily time away from home/yard and lower frequency of car transfers (r=0.367, p=0.002 and r=0.434, p<0.001 respectively). Daily distance of WCP was negatively correlated with depression (PHQ-2) (r= -0.309, p=0.004). Time in leisure PA was the only significant predictor of SWLS scores (r=0.321, p=0.003).ConclusionsShort-term recall of hours away from home/yard not spent driving or riding in a vehicle is suggested as a self-report measure that is moderately related to overall WCP PA in this population. Results of this study suggest that depression is related to decreased PA and WCP activity while, SWL is related to leisure PA.
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Are changes in gait and balance across the Disease Step Rating Scale in Multiple Sclerosis statistically significant and clinically meaningful?
Publication date: Available online 22 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Katrina L. Williams, Nancy L. Low Choy, Sandra G. Brauer
ObjectivesTo explore differences in gait endurance, speed and standing balance in people with Multiple Sclerosis (MS) across the Disease Step Rating Scale (DSRS), and to determine if differences are statistically significant and clinically meaningful.DesignObservational Study. Setting/Participants: 222 community dwelling people with MS (Mean age 48 ± 12 years; 32% male)InterventionNot applicable: Main Outcome Measures: Participants were categorised using the DSRS. Demographics and clinical measures of gait endurance (6 minute walk test - 6MWT), gait speed (10 meter walk test - 10MWT; 25foot walk test - 25FWT) and balance (Berg Balance Scale - BBS) were recorded in one session. Differences in these parameters across categories of the DSRS were explored and clinically meaningful differences identified.ResultsThe 6MWT showed a greater number of significant differences across adjacent Disease Steps in those with less disability (p < 0.001), while the 10MWT and 25FWT demonstrated more significant changes in those with greater disability (p < 0.001). The BBS demonstrated significant differences across the span of the DSRS categories (p < 0.001). Differences in gait and balance between adjacent DSRS categories met most previously established levels of minimally detectable change and all minimally important change scores.ConclusionOut findings support the DSRS is an observational tool that can be used by health professionals to categorise people with MS, with the categories reflective of statistically significant and clinically meaningful differences in gait and balance performance.
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