Cochrane Corners to Enhance Access to Evidence-Based Physiatry (EBP)

No abstract available

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Comparing assessments of physical functional independence in older adults with mobility limitations

Objectives 1) To assess the agreement and correlation between self-reported functional independence and observations of family caregivers in a heterogeneous population of community-dwelling older adults with disabilities. 2) To determine how self- and caregiver-reports correlate with evaluator rated functional independence over time. Design Data were drawn from a larger, randomized controlled trial examining the effects of a caregiver-inclusive intervention on outcomes of care recipients and their family caregivers. Functional independence measures were obtained using a self-report version of the Functional Independence Measure (care recipient FIM-SR, caregiver FIM-SR) and the Functional Autonomy Measurement System (evaluator perspective). They were administered at baseline (pre-intervention), and following the intervention at 6-, 22-, and 58-weeks. Results Bivariate correlation analyses of ninety dyads consisting of older care recipients and their family caregivers reported moderate to very strong correlations between the three functional independence measures across all time points (rS=0.45-0.91; P

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Clinical Laboratory Predictors of the Outcome of the Acute Period of Atherothrombotic Ischemic Stroke

Objectives. To clarify clinical and laboratory predictors of the acute period of atherothrombotic ischemic stroke (ATS). Materials and methods. Clinical symptomatology, the numbers of peripheral blood leukocytes in apoptosis and necrosis, and the state of the intracellular antioxidant system were assessed in 199 patients. Results and discussion. Among the clinical factors with negative influences on the course of the acute period of ATS, the most important were focus size, impairment to consciousness on day 1, initial SBP, and patient's age (regression parameter R including clinical factors on day 1 was 0.496, p = 0.01, R on day 7 was 0.739, p < 0.0001; R on day 14 was 0.620, p < 0.0001). Mitochondrial dysfunction and mitochondrion-induced apoptosis were found to have direct influences on the course of ATS in the acute period. Direct relationships were found between the severity of ATS and the number of Mito+ cells on days 1 (r = 0.742, p = 0.009) and 7 (r = 0.717; p = 0.002) and between the severity of ATS and the content of ANV+ leukocytes on days 7 (r = 0.595; p = 0.015) and 14 (r = 0.670; p = 0.007), along with a negative correlation between total SOD and Mn-SOD activities of day 7 (r = 0.628; p = 0.010 and r = 0.675; p = 0.008, respectively), which is evidence for the prognostic value of these indicators.

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Changes in the Spectral Characteristics of the Electroencephalogram during Biocontrol of Heart Rate Variability Parameters in Healthy Subjects

Objectives. To assess changes in the spectral characteristics of the electroencephalogram (EEG) in humans during single sessions of biocontrol of hart rate variability parameters using biological feedback (BFB). Materials and Methods. A total of 150 adolescents aged 16–17 years were studied. Adolescents of the BFB group (n = 110) took part in biocontrol sessions to increase vagal influences on heart rate; the control group (n = 40) remained in the state of calm wakefulness. EEG recordings were made with the eyes closed before and after BFB training. EEG characteristics were studied in terms of changes in absolute power levels (μV²) in artifact-free trace segments in each frequency range. Results and conclusions. The ability of human subjects to change the activity of heart rate parameters determines the level of action on the functions of the central autonomic regulatory structures. This biocontrol method promotes improvements in cortical stability, with increases in α and decreases in β EEG activity. Brain activity synchronization processes during biocontrol were more clearly apparent in the right hemisphere, often involving the prefrontal areas.

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Autoimmune Enteropathy: An Updated Review with Special Focus on Stem Cell Transplant Therapy

Abstract

Autoimmune enteropathy (AIE) is a complex disease affecting both children and adults. Although associated with significant morbidity and mortality, the pathophysiology of the disease and its treatment have not been well characterized. This study aims to review the medical literature available on this rare but clinically significant ailment, to help establish a better understanding of its pathophysiology and enumerate the available diagnostic and treatment modalities. A literature search was conducted on PubMed using key terms related to autoimmune enteropathy and intractable diarrhea, with no restrictions on the date of publication or language. We found a total of 98 reports of AIE published in the form of case reports and case series. The evidence reviewed suggests that AIE is a multifaceted disorder that requires a high index of suspicion in the appropriate clinical setting to be able to make an early diagnosis. Current evidence supports the use of supportive care to correct nutritional and metabolic deficiencies, and immunosuppressives and immunomodulators as directed therapies. Hematopoietic stem cell transplant is an aggressive, but successful curative modality for patients with AIE as part of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. Cumulative clinical experience with management of AIE has allowed improved outcomes in transplanted and non-transplanted AIE patients even though morbidity and mortality with are still high in patients with this condition. More research is needed to further define the role of new therapies for AIE, and a central registry with participation of multiple institutions might help share and standardize care of patients with this rare but serious condition.

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Short-Term Symptomatic Relief in Gastroesophageal Reflux Disease: A Comparative Study of Esomeprazole and Vonoprazan

Abstract

Background and Aim

Proton pump inhibitors and vonoprazan (a potassium-competitive acid blocker) are recommended as first-line treatments for gastroesophageal reflux disease (GERD). However, few reports have investigated the onset of action of these agents for GERD symptom relief. The present study compared the symptom relief of esomeprazole with that of vonoprazan via monitoring self-reported GERD symptoms after treatment initiation.

Methods

This was a prospective, multicenter, randomized, open-label, parallel group, comparative clinical study between esomeprazole (20 mg/day) and vonoprazan (20 mg/day) administered for 4 weeks to patients with GERD symptoms. Patients who had scores ≥ 8 on the Gastroesophageal Reflux Disease Questionnaire (GerdQ) were defined as having GERD and enrolled in this study. Sixty patients were randomly assigned to either the esomeprazole group (n = 30) or the vonoprazan group (n = 30). Treatment response rates in each drug group were evaluated according to the GerdQ. The Frequency Scale for the Symptoms of GERD (FSSG) scores from the 1st day after treatment initiation and the Global Overall Symptom (GOS) scale scores during treatment were also evaluated.

Results

At 4 weeks, the treatment response rates for symptom relief according to the GerdQ were 88.0% in the esomeprazole group and 81.8% in the vonoprazan group. The GOS scales, which reflect the impact of GERD symptoms, were similar for both groups. The FSSG scores decreased from the 1st to the 14th day in both groups.

Conclusions

There were no substantial differences in the symptom relief between the two groups at any time point in this short-term study.

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Malignant Transformation of Ectopic Pancreas

Abstract

Malignant transformation of ectopic pancreas tissue is a diagnostic challenge as clinical symptoms and radiographic features of these tumors are non-specific. Given the rarity of these lesions, it is usually neither suspected nor included in the diagnostic workup of different tumors. We conducted a comprehensive literature review regarding malignancy arising from ectopic pancreas for a better understanding of its frequency, clinicopathological features, and prognosis. A literature search was performed in three major databases: PubMed, Cochrane, and Web of Science. Fifty-four well-documented cases of malignant ectopic pancreas were identified in the published literature. Our analysis provided the following observations: (1) there was a slight predominance of males over females; (2) most patients with malignant transformation of ectopic pancreas were middle-aged; (3) most commonly, the tumor was located in the stomach; (4) most tumors were adenocarcinomas; (5) most frequently, the malignancy arose within a type I heterotopia according to Heinrich classification; (6) macroscopically, a subepithelial-like appearance was most frequently observed; and (7) improved prognosis for ectopic pancreatic malignancies in comparison with reported survival data for orthotopic pancreatic cancer. Even if the majority of cases of ectopic pancreas are incidental findings and malignant transformation is a rare event, pancreatic heterotopy should be considered as a source of potentially malignant lesions.

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