Determinants of change in stroke-specific quality of life after distributed constraint-induced therapy

OBJECTIVE

We identified the predictive factors of change in quality of life (QOL) after a distributed form of constraint-induced therapy (dCIT) among stroke survivors.

METHOD

Seventy-four participants were treated with dCIT. We identified eight potential determinants of change: age, gender, side of lesion, time since stroke, cognitive status, motor impairment of the upper extremity, activities of daily living (ADLs), and instrumental ADLs (IADLs). The Stroke-Specific Quality of Life Scale (SS-QOL) was used to assess QOL.

RESULTS

Right-sided lesion and onset >17 mo earlier determined greater improvement in the SS-QOL Energy domain. Onset >10 mo earlier, poorer IADL performance, and age >68 yr predicted improvement in the Family Role, Mobility, and Mood domains, respectively.

CONCLUSION

Side of lesion, time since stroke, IADL performance, and age were the most important determinants of QOL in patients receiving stroke motor rehabilitation.

Pleasant music improves visual attention in patients with unilateral neglect after stroke

OBJECTIVE

To investigate whether listening to pleasant music improves visual attention to and awareness of contralesional stimuli in patients with unilateral neglect after stroke.

METHODS

A within-subject design was used with 19 participants with unilateral neglect following a right hemisphere stroke. Participants were tested in three conditions (pleasant music, unpleasant music and white noise) within 1 week. All musical pieces were chosen by the participants. In each condition, participants were asked to complete three sub-tests of the Behavioural Inattention Test (the Star Cancellation Test, the Line Bisection Test and the Picture Scanning test) and a visual exploration task with everyday scenes. Eye movements in the visual exploration task were recorded simultaneously. Mood and arousal induced by different auditory stimuli were assessed using visual analogue scales, heart rate and galvanic skin response.

RESULTS

Compared with unpleasant music and white noise, participants rated their moods as more positive and arousal as higher with pleasant music, but also showed significant improvement on all tasks and eye movement data, except the Line Bisection Test.

CONCLUSION

The findings suggest that pleasant music can improve visual attention in patients with unilateral neglect after stroke. Additional research using randomized controlled trials is required to validate these findings.

Unilateral versus bilateral robot-assisted rehabilitation on arm-trunk control and functions post stroke: a randomized controlled trial

BACKGROUND

Although the effects of robot-assisted arm training after stroke are promising, the relative effects of unilateral (URT) vs. bilateral (BRT) robot-assisted arm training remain uncertain. This study compared the effects of URT vs. BRT on upper extremity (UE) control, trunk compensation, and function in patients with chronic stroke.

METHOD

This was a single-blinded, randomized controlled trial. The intervention was implemented at 4 hospitals. Fifty-three patients with stroke were randomly assigned to URT, BRT, or control treatment (CT). Each group received UE training for 90 to 105 min/day, 5 days/week, for 4 weeks. The kinematic variables for arm motor control and trunk compensation included normalized movement time, normalized movement units, and the arm-trunk contribution slope in unilateral and bilateral tasks. Motor function and daily function were measured by the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and ABILHAND Questionnaire.

RESULTS

The BRT and CT groups elicited significantly larger slope values (i.e., less trunk compensation) at the start of bilateral reaching than the URT group. URT led to significantly better effects on WMFT-Time than BRT. Differences in arm control kinematics and performance on the MAL and ABILHAND among the 3 groups were not significant.

CONCLUSIONS

BRT and URT resulted in differential improvements in specific UE/trunk performance in patients with stroke. BRT elicited larger benefits than URT on reducing compensatory trunk movements at the beginning of reaching. In contrast, URT produced better improvements in UE temporal efficiency. These relative effects on movement kinematics, however, did not translate into differential benefits in daily functions.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00917605.

Gender difference of childhood overweight and obesity in predicting the risk of incident asthma: a systematic review and meta-analysis

The aims of our meta-analysis were (i) to quantify the predictability of childhood overweight and obesity on the risk of incident asthma; and (ii) to evaluate the gender difference on this relationship. The selection criteria included prospective cohort paediatric studies which use age- and sex-specific body mass index (BMI) as a measure of childhood overweight and the primary outcome of incident asthma. A total of 1,027 studies were initially identified through online database searches, and finally 6 studies met the inclusion criteria. The combined result of reported relative risk from the 6 included studies revealed that overweight children conferred increased risks of incident asthma as compared with non-overweight children (relative risk, 1.19; 95% confidence interval [CI], 1.03-1.37). The relationship was further elevated for obesity vs. non-obesity (relative risk, 2.02; 95% CI, 1.16-3.50). A dose-responsiveness of elevated BMI on asthma incidence was observed (P for trend, 0.004). Obese boys had a significantly larger effect than obese girls (relative risk, boys: 2.47; 95% CI, 1.57-3.87; girls: 1.25; 95% CI, 0.51-3.03), with significant dose-dependent effect. Proposed mechanisms of gender difference could be through pulmonary mechanics, sleep disordered breathing and leptin. Further research might be needed to better understand the exact mechanism of gender difference on the obesity-asthma relationship.

Effects of Constraint-Induced Therapy Combined With Eye Patching on Functional Outcomes and Movement Kinematics in Poststroke Neglect

OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk–arm kinematics in stroke patients with neglect syndrome.

METHOD. Twenty-four participants were recruited and randomly allocated to three intervention groups. All participants received intervention 2 hr/day, 5 days/wk, for 3 wk. Outcome measures included the Catherine Bergego Scale, eye movement, and trunk–arm kinematic analysis.

RESULTS. The CIT + EP and CIT groups demonstrated larger improvements in functional performance than the control group. The CIT group showed better performance with left fixation points than the CIT+EP group and shorter reaction time than the control group. The CIT + EP group improved more in preplanned control and leftward trunk shift than the other two groups.

CONCLUSION. CIT + EP and CIT were more effective interventions than conventional treatment of patients with neglect syndrome in daily functional performance.

Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial

OBJECTIVE

To compare the effects of mirror therapy (MT) versus control treatment (CT) on movement performance, motor control, sensory recovery, and performance of activities of daily living in people with chronic stroke.

DESIGN

Single-blinded, randomized controlled trial.

SETTING

Four hospitals.

PARTICIPANTS

Outpatients with chronic stroke (N=33) with mild to moderate motor impairment.

INTERVENTIONS

The MT group (n=16) received upper extremity training involving repetitive bimanual, symmetrical movement practice, in which the individual moves the affected limb while watching the reflective illusion of the unaffected limb's movements from a mirror. The CT group received task-oriented upper extremity training. The intensity for both groups was 1.5 hours/day, 5 days/week, for 4 weeks.

MAIN OUTCOME MEASUREMENTS

The Fugl-Meyer Assessment; kinematic variables, including reaction time, normalized movement time, normalized total displacement, joint recruitment, and maximum shoulder-elbow cross-correlation; the Revised Nottingham Sensory Assessment; the Motor Activity Log; and the ABILHAND questionnaire.

RESULTS

The MT group performed better in the overall (P=.01) and distal part (P=.04) Fugl-Meyer Assessment scores and demonstrated shorter reaction time (P=.04), shorter normalized total displacement (P=.04), and greater maximum shoulder-elbow cross-correlation (P=.03). The Revised Nottingham Sensory Assessment temperature scores improved significantly more in the MT group than in the CT group. No significant differences on the Motor Activity Log and the ABILHAND questionnaire were found immediately after MT or at follow-up.

CONCLUSIONS

The application of MT after stroke might result in beneficial effects on movement performance, motor control, and temperature sense, but may not translate into daily functions in the population with chronic stroke.

Ability of three motor measures to predict functional outcomes reported by stroke patients after rehabilitation

OBJECTIVE

This investigation examined the demographic characteristics along with 3 measures of motor function in determining outcomes in activities of daily living (ADL) after distributed constraint-induced therapy (dCIT).

METHODS

The study recruited 69 stroke patients who received 3 weeks of dCIT for 2 hours daily, 5 days a week. The self-reported outcome measures for daily function were the Motor Activity Log (MAL) including the amount of use (AOU) and quality of movement (QOM), Nottingham Extended Activities of Daily Living Questionnaire (NEADL), and the Stroke Impact Scale (SIS). Age, sex, onset, side of stroke, Fugl-Meyer assessment (FMA), Wolf Motor Function Test (WMFT), and Action Research Arm Test (ARAT) were the potential predictors.

RESULTS

The ARAT grasp-grip-pinch score was the most dominant predictor for MAL-AOU and NEADL (P< 0.05), and the ARAT total score for the subscore of the ADL/instrumental ADL section of the SIS (P< 0.05). The FMA wrist-hand score was a significant predictor for MAL-QOM (P< 0.05). Age was the only demographic factor that significantly predicted NEADL performance (P< 0.05).

CONCLUSION

Among the 3 commonly used measures of motor function after stroke, ARAT was the strongest determinant in predicting MAL-AOU, MAL-QOM, and SIS-ADL/instrumental ADL after dCIT.

Effect of mirror therapy combined with somatosensory stimulation on motor recovery and daily function in stroke patients: A pilot study

BACKGROUND/PURPOSE

Mirror therapy (MT) has been recommended as a simple, inexpensive approach to treat motor dysfunction. The use of a mesh glove (MG) was suggested to normalize muscle tone that ameliorates motor impairment. Combining two efficient treatment protocols might maximize the benefits from training. This study investigated the effects of MT combined with MG (MG + MT) versus MT alone on motor performance and daily function after stroke.

METHODS

Sixteen patients with chronic unilateral stroke were recruited. A randomized two-group pretest and posttest design was used to randomly assign participants to MG + MT or MT groups. MT involves repetitive bimanual, symmetrical movement practice in which the individual moves the affected limb as much as she/he could while watching the reflective illusion of the unaffected limb's movements from a mirror. The MG + MT group wore a MG on the affected hand during the MT. The Modified Ashworth scale of muscle spasticity (MAS), Action Research Arm Test (ARAT), Box and Block Test (BBT), and Functional Independence Measure (FIM) were administered to evaluate spasticity, and motor and daily function.

RESULTS

The results for the BBT (p = 0.013), total scores (p = 0.031), grasping subscales (p = 0.036) of ARAT, and FIM transfer scores (p = 0.013) presented significantly large effects in favor of the MG + MT group.

CONCLUSION

Combining MG with MT significantly improves manual dexterity, grasping, and transfer performance. Adding the MG component into the MT likely increased the richness of sensory input and improved the movement performance more than MT alone.

Relative and absolute reliabilities of the myotonometric measurements of hemiparetic arms in patients with stroke

OBJECTIVE

To investigate the relative and absolute reliabilities of the myotonometer.

DESIGN

Psychometric study.

SETTING

Three medical centers.

PARTICIPANTS

Patients with stroke (N=61).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Muscle tone, elasticity, and stiffness of relaxed affected deltoid, triceps brachii, biceps brachii, extensor digitorum, flexor carpi radialis, and flexor carpi ulnaris were measured twice, 30 minutes apart, using the myotonometer. Intraclass correlation coefficient, a relative reliability index, was calculated for 3 muscular properties and for each muscle to examine the degree of consistency and agreement between the 2 test sessions. Absolute reliability indices, including the SEM, smallest real difference, and Bland-Altman limits of agreement, were used to quantify measurement errors and check systematic biases of the 2 test sessions.

RESULTS

The intraclass correlation coefficients were .83 to .95 for muscle tone, elasticity, and stiffness of all muscle groups. The SEM and the smallest real difference of muscle tone, elasticity, and stiffness of the biceps were the smallest among the 6 muscles tested. The Bland-Altman analyses showed no systematic bias between most of the repeated measurements. Compared with other muscles, biceps had narrower limits-of-agreement ranges, indicating that the myotonometric measurements of the biceps had higher stability and less variation over time.

CONCLUSIONS

The myotonometer reliably measures muscular properties, with good relative and absolute reliabilities. These findings are useful for clinicians and researchers to assess muscle properties reliably and determine whether a real change has occurred in groups and on individual levels of patients with stroke.

Combination of baclofen and antimuscarinics to reduce voiding difficulty in treating women with overactive bladders

PURPOSE OF STUDY

To evaluate the efficacy of baclofen in combination with antimuscarinics to treat women with an overactive bladder (OAB) with abnormal voiding patterns.

METHODS

An action research and chart review was conducted in 245 OAB women. Women were prescribed tolterodine or oxybutynin with or without baclofen after urodynamics. The complaint of voiding difficulty was followed up one week later.

RESULTS

There was a significant difference in the occurrence of voiding difficulty after antimuscarinic administration in OAB women with abnormal voiding patterns compared with normal patterns (18% vs 4.9%, respectively; p = 0.013). The clinical difference of voiding difficulty after treating with antimuscarinics between both voiding patterns disappeared after adding baclofen (abnormal voiding pattern vs normal pattern; 11.1% vs. 5.6%, respectively; p = 1.000).

CONCLUSION

Combined use of baclofen and antimuscarinic agents could reduce voiding difficulty in treating women with overactive bladders with abnormal voiding patterns.

Effects of spiked metals on the MSW anaerobic digestion

This study aimed to investigate the effects of eight metals on the anaerobic digestion of the organic fraction of municipal solid waste (OFMSW) in bioreactors. Anaerobic bioreactors containing 200 mL MSW mixed completely with 200 m L sludge seeding. Ca and K (0, 1000, 2000 and 6,000 mg L(-1)) and Cr, Ni, Zn, Co, Mo and W (0, 5, 50 and 100 mg  L(-1)) of various dose were added to anaerobic bioreactors to examine their anaerobic digestion performance. Results showed that except K and Zn, Ca (~728 to ~1,461 mg  L(-1)), Cr (~0.0022 to ~0.0212 mg  L(-1)), Ni (~0.801 to ~5.362 mg  L(-1)), Co (~0.148 to ~0.580 mg  L(-1)), Mo (~0.044 to ~52.94 mg  L(-1)) and W (~0.658 to ~40.39 mg  L(-1)) had the potential to enhance the biogas production. On the other hand, except Mo and W, inhibitory concentrations IC(50) of Ca, K, Cr, Ni, Zn and Co were found to be ~3252, ~2097, ~0.124, ~7.239, ~0.482, ~8.625 mg  L(-1), respectively. Eight spiked metals showed that they were adsorbed by MSW to a different extent resulting in different liquid metals levels and potential stimulation and inhibition on MSW anaerobic digestion. These results were discussed and compared to results from literature.

Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial

OBJECTIVE

To compare the outcome of robot-assisted therapy with dose-matched active control therapy by using accelerometers to study functional recovery in chronic stroke patients.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Stroke units in three medical centres.

SUBJECTS

Twenty patients post stroke for a mean of 22 months.

INTERVENTION

Robot-assisted therapy (n = 10) or dose-matched active control therapy (n = 10). All patients received either of these two therapies for 90-105 minutes each day, 5 days per week, for four weeks.

MAIN MEASURES

Outcome measures included arm activity ratio (the ratio of mean activity between the impaired and unimpaired arm) and scores on the Fugl-Meyer Assessment Scale, Functional Independence Measure, Motor Activity Log and ABILHAND questionnaire.

RESULTS

The robot-assisted therapy group significantly increased motor function, hemiplegic arm activity and bilateral arm coordination (Fugl-Meyer Assessment Scale: 51.20 ± 8.82, P = 0.002; mean arm activity ratio: 0.76 ± 0.10, P = 0.026; ABILHAND questionnaire: 1.24 ± 0.28, P = 0.043) compared with the dose-matched active control group (Fugl-Meyer Assessment Scale: 40.90 ± 13.14; mean arm movement ratio: 0.69 ± 0.11; ABILHAND questionnaire: 0.95 ± 0.43).

CONCLUSIONS

Symmetrical and bilateral robotic practice, combined with functional task training, can significantly improve motor function, arm activity, and self-perceived bilateral arm ability in patients late after stroke.

Epizootic myocarditis associated with encephalomyocarditis virus in a group of rhesus macaques (Macaca mulatta)

Six cases of fatal myocarditis associated with encephalomyocarditis virus occurred over a 14-month period in a group of outdoor-housed juvenile rhesus macaques. All animals were younger than 3 years of age and died or were euthanized following acute onset of dyspnea or pulmonary effusion (3 of 6) or were found dead without premonitory signs (3 of 6). Gross findings included pulmonary congestion (6 of 6), variable degrees of pleural effusion (4 of 6), multifocal pale tan foci throughout the myocardium (3 of 6), hepatomegaly and hepatic congestion (3 of 6), and pericardial effusion (1 of 6). Histologically, affected myocardium was infiltrated multifocally by lymphoplasmacytic and histiocytic inflammation admixed with necrotic and degenerate myofibers and infrequent mineralization (6 of 6). Pulmonary edema was present in all animals. Encephalomyocarditis virus was confirmed in 6 of 6 hearts by immunohistochemistry, and virus was isolated from one case by polymerase chain reaction. Sequencing of virus isolated from 1 affected animal indicated infection with a novel encephalomyocarditis virus. Encephalomyocarditis virus should be considered as a differential etiology in outbreaks of myocarditis and pulmonary edema in juvenile primates.

Relationship between Hemispatial Inattention and Performance of Activities of Daily Living in Patients with Schizophrenia

This study investigated the relation of hemispatial inattention to the performance of daily functions in 32 patients with schizophrenia or schizoaffective disorder and in 31 healthy controls. They were tested on the relationship between a target cancellation task and the Activities of Daily Living Rating Scale–II (ADLRS–II). According to the results of the hemispatial inattention test, the patients with schizophrenia made more omissions in the cancellation test than the controls. In addition, the results showed a significant correlation between number of omissions on the cancellation test and the ADLRS–II score in the study participants. A statistically significant relationship was observed between hemispatial inattention and the functional status of patients with schizophrenia, and suggests the need to incorporate measures of visual attention into psychiatric rehabilitation assessments.

Brain reorganization after bilateral arm training and distributed constraint-induced therapy in stroke patients: a preliminary functional magnetic resonance imaging study

BACKGROUND

Bilateral arm training (BAT) and constraint-induced therapy (CIT) have shown beneficial effects in improving motor control and function of the upper extremities (UE) for patients with stroke. Thus far, no study has directly investigated the relative effects of BAT versus CIT on brain reorganization. This study compared the effects of BAT with distributed CIT (dCIT) on brain reorganization and motor function in 6 stroke patients.

METHODS

In a pre-post randomized controlled trial, 6 stroke patients received BAT (intensive bilateral simultaneous and symmetrical training) or dCIT (restraint of the unaffected UE combined with intensive training of the affected UE) for a period of 3 weeks, 5 days per week. Functional magnetic resonance imaging (fMRI) examination and 3 clinical measures (Fugl-Meyer Assessment, Action Research Arm Test, and Motor Activity Log) were administered before and after the intervention.

RESULTS

After intervention, patients showed varied patterns of fMRI changes and improved motor function. Two well-recovered patients, one from each group, showed large increases in bilateral hemisphere activation, especially in the ipsilesional hemisphere during affected hand movement and in the contralesional hemisphere during unaffected hand movement. During bilateral elbow movement, 3 of the 4 BAT patients showed increased bilateral cerebellum activation, especially in the left cerebellum, whereas 2 dCIT patients showed decreased cerebellar activation.

CONCLUSIONS

The findings of this preliminary research revealed that neuroplastic changes after stroke motor rehabilitation may be specific to the intervention. Further research using a larger sample and more complex fMRI tasks is warranted to validate the findings.

Relationships between developmental profiles and ambulatory ability in A follow-up study of preschool children with spastic quadriplegic cerebral palsy

BACKGROUND

To investigate the follow-up course of developmental profiles in preschool children with spastic quadriplegic (SQ) cerebral palsy (CP) who had varying ambulatory abilities.

METHODS

Forty-eight children with SQ CP between 1 and 5 years old were classified into 2 groups, the ambulatory and non-ambulatory groups, based on Gross Motor Function Classification System (GMFCS) levels during the initial assessment. The developmental profiles, consisting of development quotients (DQs) of 8 domains, were evaluated during the initial assessment and the final assessment one year later. The DQ change index (%) was calculated as 100% X (final DQ-initial DQ)/initial DQ.

RESULTS

The DQs of all developmental domains in the non-ambulatory group were lower than those in the ambulatory group on both initial and final assessments (p<0.01). As indicated by the DQ change indices, most DQs in the ambulatory group decreased slightly, whereas those in the non-ambulatory group decreased considerably (p<0.05). Furthermore, fine motor function increased proportionally with age in the ambulatory group, but not in the non-ambulatory group.

CONCLUSION

The DQs of the developmental profiles varied in preschool CP children with different ambulatory abilities. The course of developmental profiles in preschool children with SQ CP evolves with age and relates to the degree of ambulatory function. Knowledge of these developmental profiles may be helpful in understanding, predicting, and managing the developmental problems of these children.

Modeling biogas production from organic fraction of MSW co-digested with MSWI ashes in anaerobic bioreactors

This study aims at investigating the effects of MSW incinerator fly ash (FA) and bottom ash (BA) on the anaerobic co-digestion of OFMSW with FA or BA. It also simulates the biogas production from various dosed and control bioreactors. Results showed that suitable ashes addition (FA/MSW 10 and 20 g L(-1) and BA/MSW 100 g L(-1)) could improve the MSW anaerobic digestion and enhance the biogas production rates. FA/MSW 20 g L(-1) bioreactor had the higher biogas production and rate implying the potential option for MSW anaerobic co-digestion. Modeling studies showed that exponential plot simulated better for FA/MSW 10 g L(-1) and control bioreactors while Gaussian plot was applicable for FA/MSW 20 g L(-1) one. Linear and exponential plot of descending limb both simulated better for BA/MSW 100 g L(-1) bioreactor. Modified Gompertz plot showed higher correlation of biogas accumulation than exponential rise to maximum plot for all bioreactors.

Factors associated with motor speech control in children with spastic cerebral palsy

BACKGROUND

Speech production is often impaired in children with cerebral palsy (CP). This study investigated the factors associated with motor speech control in children with spastic cerebral palsy.

METHODS

Thirty-three children with spastic CP who were able to speak were identified for this study. They were classified into two groups: group A (spastic diplegia or hemiplegia, n = 17) and group B (spastic quadriplegia, n = 16). Each child received various assessments, namely cognition, language, modified Verbal Motor Production Assessment for Children (VMPAC), speech intelligibility, CP subtype, and Gross Motor Function Classification System (GMFCS).

RESULTS

Group A showed better cognition and language function, higher modified VMPAC scores and better GMFCS levels than group B (p < 0.05). However, the two groups did not significantly differ in speech intelligibility. Linear regression indicated that all modified VMPAC scores were negatively related to CP subtype (adjusted r2 = 0.51~0.63, p < 0.001). The average modified VMPAC scores had a positive relationship with global language scores (adjusted r2 = 0.63, p < 0.001), and the modified VMPAC scores of the sequence subtests were positively related to the full intelligence quotients (adjusted r2 = 0.55, p < 0.001).

CONCLUSION

The findings of this study suggest that motor impairment severity, cognition and language functions are associated with the motor speech control among children with CP.

Comparison of developmental pattern change in preschool children with spastic diplegic and quadriplegic cerebral palsy

BACKGROUND

This study compares the longitudinal change of developmental patterns in preschool children with spastic diplegic (SD) and spastic quadriplegic (SQ) cerebral palsy (CP).

METHODS

Sixty children with spastic CP, aged 1-5 years (3.2 +/- 1.2 years), were classified into 2 groups: SD (n = 29) and SQ (n = 31). Gross Motor Function Classification System (GMFCS) levels were classified during the initial assessments. Developmental profiles, including development quotients (DQs) of gross motor, fine motor, expressive language, concept comprehension, situation comprehension, self help, personal social and general development, were evaluated on initial and final assessments and an average of one year later. The DQ change index (%) was calculated as 100% x (final DQ - initial DQ)/initial DQ.

RESULTS

Children with SQ had lower DQs in all developmental functions than those with SD on both assessments (p < 0.01). The DQ distributions of developmental profiles were different in SD and SQ groups, although both groups displayed the lowest DQs in the gross motor domain. As indicated by the DQ change index, most DQs increased with age in children with SD; however, most decreased with age in children with SQ (p < 0.05).

CONCLUSION

These findings suggest different CP subtypes demonstrate various development profiles. The evolvement of developmental patterns with age was different in children with various CP subtypes.

Small intestinal adenocarcinoma in common marmosets (Callithrix jacchus)

Small intestinal adenocarcinomas are uncommon neoplasms that are rarely reported in nonhuman primates. These neoplasms are also rare in humans, although they are thought to share a similar pathogenesis with the more common colorectal carcinoma. Herein the authors report the clinical, histologic, immunohistochemical, and molecular characteristics of small intestinal adenocarcinoma in 10 common marmosets (Callithrix jacchus). Retrospective analysis of necropsy records revealed small intestinal carcinoma to be the most common neoplastic cause of morbidity and mortality in aged common marmosets. The average age of affected animals was 6.6 years old, and there was no sex predilection. Nine of 10 (90%) tumors arose within the proximal small intestine near the interface with the duodenum. All cases were characterized by disorganization, loss of polarity, and proliferation of neoplastic epithelial cells along the crypt to midvillous interface. Two of 10 (20%) were defined as carcinoma in situ. Eight of 10 (80%) had some degree of invasion, with lymphatic invasion and lymph node metastasis present in 6 of 10 (60%) animals. Immunohistochemically, 10 of 10 (100%) expressed cytokeratin; 7 of 9 (77%) expressed E-cadherin; and 8 of 9 (88%) expressed beta-catenin. The expression of E-cadherin and beta-catenin was decreased in the cell membrane and increased in the cytoplasm. No Helicobacter-like bacteria were observed via silver stain, and callitrichine herpesvirus 3 was detected by polymerase chain reaction with equal frequency from neoplastic and nonneoplastic intestinal sections. The tumors described in this population illustrate comparable features to human cases of small intestine carcinoma and may serve as a potential animal model for small intestinal carcinomas.

Neonatal Candidemia Exacerbated the Progression of Retinopathy of Prematurity in an Extremely-Low-Birth-Weight Infant with Persistent Tunica Vasculosa Lentis

Eyes with threshold retinopathy of prematurity (ROP) often show dilation of the existing tunica vasculosa lentis (TVL), which is a prognostic factor in ROP screening and treatment, but can be frequently misdiagnosed as true iris neovascularization (NV). Besides, candidemia in preterm infants can aggravate the severity of ROP, possibly to the threshold stage requiring laser treatment. A case of prolonged candidemia without ophthalmic infection in an extremely-low-birth-weight (ELBW) (birth weight: 800 g), pre-term (gestation: 26 weeks) infant with persistent TVL and severe ROP are reported. The threshold ROP was successfully treated with argon laser therapy. Candidemia without eye infection in this case was associated with early use of a systemic antifungal drug. To our knowledge, no similar cases have been reported in the literature.

Comparison between hospital-based and community-based services for the special health care needs of children with developmental delays

BACKGROUND

Recognizing special health care needs (SHCN) is obligatory for children with developmental delay (DD). The purpose of this study was to compare hospital-based and community-based services for the SHCN of children with DD.

METHODS

We collected 114 children with DD. An expert-designed questionnaire was used to measure the SHCN of children in either hospital-based or community-based services. The questionnaire included the children's characteristics, family ecology and SHCN, which encompassed four categories, team assessment and counseling, rehabilitation, complementary and alternative treatment, and home care. We compared the differences and needs between the two health care services.

RESULTS

More children with DD in hospital-based services had disabled certificates, catastrophic illness certificates and multiple caregivers than community based services. More children with DD in community-based services had severe-disabled certificates than those in hospital-based services (p < 0.001). Children in hospital-based services had more SHCN for some items of team assessment and counseling, rehabilitation, and complementary and alternative treatment than those in community-based services (p < 0.05). The need for home care was not significantly different between the two services except for nutrition counseling (p = 0.048).

CONCLUSION

SHCN in multiple aspects imply the necessity for team assessment and counseling, rehabilitation, complementary and alternative treatments and nutrition counseling in approaching children with DD in hospital-based services.

Psychometric comparisons of the Stroke Impact Scale 3.0 and Stroke-Specific Quality of Life Scale

PURPOSE

This study compared the responsiveness and criterion-related validity of the Stroke Impact Scale (SIS) and Stroke-Specific Quality of Life Scale (SS-QOL) for patients after stroke rehabilitation.

METHODS

The SIS and SS-QOL, along with five criterion measures-the Fugl-Meyer Assessment, the Motor Activity Log, the Functional Independence Measure, the Frenchay Activities Index, and the Nottingham Extended Activities of Daily Living Scale-were administered to 74 patients with stroke before and after a 3-week intervention. Responsiveness was examined using the Wilcoxon signed rank test and standardized response mean (SRM). Criterion-related validity was investigated using the Spearman correlation coefficient (rho).

RESULTS

Whereas the SS-QOL subscales were nonresponsive to changes, the SIS hand function showed medium responsiveness (SRM = .52, Wilcoxon Z = 4.24, P < .05). Responsiveness of the SIS total also was significantly larger than that of the SS-QOL total (SRM difference, .36; 95% confidence interval, .02-.71). Criterion validity of the SIS hand function was good (rho = .51-.68; P < .01), but that of the SS-QOL was only fair (rho = .25-.31; P < .05).

CONCLUSION

Because the SIS had better overall responsiveness and the SIS hand function showed medium responsiveness and good criterion validity, the SIS appears to be more suited for assessing changes after stroke rehabilitation.

Nanocontact resistance and structural disorder induced resistivity variation in metallic metal-oxide nanowires

Several systems of metallic metal-oxide nanowires (NWs), including pure RuO2 and as-implanted and annealed Ru(0.98)Cu(0.02)O2 and Ru(0.93)Cu(0.07)O2 NWs, have been employed in two-probe electrical characterizations by using a transmission electron microscope-scanning tunneling microscope technique with a gold tip. Thermal, mechanical, and electron beam exposing treatments are consecutively applied to reduce the electrical contact resistance, generated from the interface between the NW and the gold tip, so as to evaluate the intrinsic NW resistance. It is found that the residual contact resistance cannot be entirely removed. For each system of metallic metal-oxide NWs, several tens of NWs are applied to electrical characterizations and the total resistances unveil a linear dependence on the ratio of the length to the area of the NWs. As a result, the average resistivity and the contact resistance of the metallic metal-oxide NWs could be evaluated at room temperatures. The average resistivities of pure RuO2 NWs agree well with the results obtained from standard two- and four-probe electrical-transport measurements. In addition, the as-implanted Cu-RuO2 NWs reveal disordered crystalline structures in high-resolution TEM images and give higher resistivities in comparison with that of pure RuO2 NWs. The residual contact resistances of all kinds of metallic metal-oxide NWs unveil, more surprisingly, an approximation value of several kilohms, even though the average resistivities of these NWs change by more than one order of magnitude. It is argued that the ductile gold tip makes one or more soft contacts on the stiff metal-oxide NWs with nanometer roughness and the nanocontacts on the NWs contribute to the electrical contact resistance.