Distinct patterns of fiber type adaptation in rat hindlimb muscles 4 weeks after hemorrhagic stroke

Objective The aim of this study was to evaluate adaptations in soleus (SOL) and tibialis anterior (TA) muscles in a rat model 4 weeks after hemorrhagic stroke. Design Young adult Sprague-Dawley rats were randomly assigned to two groups: stroke (STR) and control (CTRL), with 8 SOL and 8 TA muscles per group. Hemorrhagic stroke was induced in the right caudoputamen of the STR rats. CTRL rats had no intervention. Neurologic status was evaluated in both groups pre-stroke, and four weeks post-stroke. Muscles were harvested after post-stroke neurologic testing. Muscle fiber types and cross-sectional areas were determined in SOL and TA using immunohistochemical labeling for myosin heavy chain (MHC). Results No generalized fiber atrophy was found in any of the muscles. Fiber types shifted from faster to slower in the TA of the STR group, but no fiber type shifts occurred in the SOL muscles of STR animals. Conclusion Since slower MHC fiber types are associated with weaker contractile force and slower contractile speed, this faster-to-slower fiber type shift in TA muscles may contribute to weaker and slower muscle contraction in this muscle after stroke. This finding may indicate potential therapeutic benefit from treatments known to influence fiber type plasticity. Corresponding author: L. Snow, MMC 388, 420 Delaware St. SE, Minneapolis, MN 55455, Phone: 612-626-5782, FAX: 612-625-4274, Email: snow0018@umn.edu Disclosures: Funding: NIH-K08HD049459 Competing interests and financial benefits to authors: none The results of this study have not been previously presented at any professional association meeting. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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More Than Just a Game: The Public Health Impact of Sport and Physical Activity for People With Disabilities (The 2017 DeLisa Lecture)

Although people with disabilities make up a large proportion of our global population and are known to be disproportionately impacted by sedentary lifestyles leading to chronic disease, programs promoting physical activity often fail to address their unique needs. Both environmental and attitudinal factors also act as barriers to full participation. In this context, increasing evidence shows the positive impact of physical activity and sport on outcomes related to physical health, mental health, community participation, and, in some cases, neurorecovery for people with disabilities. Thus, participation should be seen not only as a medical intervention, but also as a rights-based issue. We, as physiatrists, can be agents of change by promoting concepts of universal design and inclusion in physical activity and sport programs. Corresponding Author: Cheri A. Blauwet, MD, Assistant Professor of PM&R, Harvard Medical School, Director, Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, Office: 617 732 9702, Fax: 617 732 9576, cblauwet@bwh.harvard.edu Acknowledgements The lead author would like to thank Peter Wilson-Braun for assistance in manuscript formatting and figure development. This work was supported by funds from the Kelley Adaptive Sports Research Institute. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Intra- and Interrater Reliability and Concurrent Validity of a New Tool for Assessment of Breast Cancer related Lymphedema of the Upper Extremity (CLUE)

Publication date: Available online 4 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Bryan Spinelli, Michael J. Kallan, Xiaochen Zhang, Andrea Cheville, Andrea Troxel, Joy Cohn, Lorraine Dean, Kathleen Sturgeon, Margaret Evangelista, Zi Zhang, David Ebaugh, Kathryn H. Schmitz

Abstract

Objective

The goal of this study was to develop and assess intra and inter-rater reliability and validity of a clinical evaluation tool for breast cancer related lymphedema, for use in the context of outcome evaluation in clinical trials

Design

Blinded repeated measures observational study.

Setting

Outpatient research laboratory.

Participants

Breast cancer survivors with and without lymphedema (N=71).

Interventions

Not applicable.

Main outcome measure

The assessment of Intraclass Correlations (ICCs) for the Breast Cancer related Lymphedema in the Upper Extremity (CLUE) standardized clinical evaluation tool.

Results

Intra-rater reliability for the CLUE tool was ICC: 0.88 (95% CI: 0.71, 0.96). Inter-rater reliability for the CLUE tool was ICC: 0.90 (95% CI: 0.79, 0.95). Concurrent validity of the CLUE score (Pearson's r) was 0.79 with perometric inter-limb difference, and 0.53 with the Norman Lymphedema overall score.

Conclusions

The CLUE tool shows excellent inter- and intra-rater reliability. The overall CLUE score for the upper extremity also shows moderately strong concurrent validity with objective and subjective measures. This newly developed clinical, physical assessment of upper extremity lymphedema provides standardization and a single score that accounts for multiple constructs. Next steps include evaluation of sensitivity to change, which would establish usefulness to evaluate intervention efficacy.

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Skilled Nursing Facility Participation in Medicare’s Bundled Payments for Care Improvement Initiative: A Retrospective Study

Publication date: Available online 4 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Lianna Weissblum, Peter Huckfeldt, José Escarce, Pinar Karaca-Mandic, Neeraj Sood

Abstract

Objective

To investigate differences in facility characteristics, patient characteristics, and outcomes between skilled nursing facilities (SNFs) that participated in Medicare's voluntary Bundled Payments for Care Improvement (BPCI) initiative and non-participants, prior to BPCI.

Design

Retrospective, cross-sectional comparison of BPCI participants and non-participants.

Setting

SNFs

Participants

All Medicare-certified SNFs (n = 15,172) and their 2011-2012 episodes of care for chronic obstructive pulmonary disease, congestive heart failure, femur and hip/pelvis fracture, hip and femur procedures, lower extremity joint replacement, and pneumonia (n = 873,739).

Interventions

Participation in a bundled payment program that included taking financial responsibility for care within a 90 day episode.

Main Outcome Measures

This study investigates the characteristics of bundled payment participants and their patient characteristics and outcomes relative to non-participants prior to BPCI, to understand the implications of a broader implementation of bundled payments.

Results

SNFs participating in BPCI were more likely to be in urban areas (80.8-98.4% versus 69.5%) and belong to a chain or system (73.8-85.5% versus 55%), and were less likely to be located in the south (13.1-20.2% versus 35.4%). Quality performance was similar or higher in most cases for SNFs participating in BPCI relative to non-participants. In addition, BPCI participants admitted higher socioeconomic status patients with similar clinical characteristics. Initial SNF length of stay was shorter and hospital readmission rates were lower for BPCI patients compared to non-participant patients.

Conclusions

We found that SNFs participating in the second financial risk-bearing phase of BPCI represented a diversity of SNF types, regions, and levels of quality and the results may provide insight into a broader adoption of bundled payment for post-acute providers.

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Data: How often does EMS respond to injured football players

ePCR data from more than 1,000 EMS agencies filtered to understand frequency and type of football players injuries

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Detection of radon with biosensors based on the lead(II)-induced conformational change of aptamer HTG and malachite green fluorescence probe

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 195

Author(s): Shiya Li, Hongwen Liu, Guiying Yang, Shimeng Liu, Ran Liu, Changyin Lv

Abstract

The aim of this paper is to assemble a new biosensor for detecting the accumulated radon dose in the environment to achieve rapid monitor of radon. Based on the correlation between radon and its stable decay daughter ²¹⁰Pb, a biosensor using the lead-induced specific aptamer HTG conformational changes, and the organic dye malachite green (MG) as a fluorescent probe was assembled. In these studies, we explored a novel, sensitive, label-free, fluorescence biosensing method for the detection of both radon and lead. The fluorescence intensity difference has a linear relationship with Pb²⁺ and the accumulated radon concentration from 6.87 × 10³ Bq·h/m³ to 3.49 × 10⁵ Bq·h/m³. The lead and radon detection limits of this method are 6.7 nmol/L and 2.06 × 10³ Bq·h/m³, respectively. The student's t-test results indicated that the new method was reliable and stable. The detection method is sensitive, accurate, easy to operate, has a wide linear range and is highly selective. In the sampling and determination processes of radon, the radiation harm to human health can be effectively avoided.

Graphical abstract

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Dabigatran Reduces Liver Fibrosis in Thioacetamide-Injured Rats

Abstract

Background

Liver fibrosis can progress to cirrhosis, hepatocellular carcinoma, or liver failure. Unfortunately, the antifibrotic agents are limited. Thrombin activates hepatic stellate cells (HSCs). Therefore, we investigated the effects of a direct thrombin inhibitor, dabigatran, on liver fibrosis.

Methods

Adult male Sprague–Dawley rats were injected intraperitoneally with thioacetamide (TAA, 200 mg/kg twice per week) for 8 or 12 weeks to induce liver fibrosis. The injured rats were assigned an oral gavage of dabigatran etexilate (30 mg/kg/day) or vehicle in the last 4 weeks of TAA administration. Rats receiving an injection of normal saline and subsequent oral gavage of dabigatran etexilate or vehicle served as controls.

Results

In the 8-week TAA-injured rats, dabigatran ameliorated fibrosis, fibrin deposition, and phosphorylated ERK1/2 in liver, without altering the transcript expression of thrombin receptor protease-activated receptor-1. In vitro, dabigatran inhibited thrombin-induced HSC activation. Furthermore, dabigatran reduced intrahepatic angiogenesis and portal hypertension in TAA-injured rats. Similarly, in the 12-week TAA-injured rats, a 4-week treatment with dabigatran reduced liver fibrosis and portal hypertension.

Conclusions

By inhibiting thrombin action, dabigatran reduced liver fibrosis and intrahepatic angiogenesis. Dabigatran may be a promising therapeutic agent for treatment of liver fibrosis.

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