The effects of Robotic-Assisted Locomotor training on spasticity and volitional control

We studied the effects of Robotic-Assisted Locomotor (LOKOMAT) Training on spasticity and volitional control of the spastic ankle in persons with incomplete Spinal Cord Injury (SCI). LOKOMAT training was performed 3 days/week during a 1-hr period including set-up time with up to 30 minutes of training during a single session. The training was provided for 4 weeks and subjects were evaluated before and after 1, 2, and 4 weeks of training. Spasticity was charterized in terms of neuromuscular abnormalities associated with the spastic joint. A system identification technique was used to quantify the effects of LOKOMAT training on these neuromuscular abnormalities. The effect of LOKOMAT training on volitional control was determined by measuring isometric maximum voluntary contraction (MVC) of ankle extensor and flexor muscles. Our results indicated that the reflex stiffness, abnormally increases in SCI, was significantly reduced (up to 65%) following 4-weeks of LOKOMAT training. Similarly, intrinsic (muscular) stiffness, which also abnormally increases in SCI, decreased significantly (up to 60%). MVCs were increased substantially (up to 93% in extensors and 180% in flexors) following 4-week training. These findings demonstrate that LOKOMAT training is effective in reducing spasticity and improving volitional control in SCI.

Robotic-assisted locomotor training impact on neuromuscular properties and muscle strength in spinal cord injury

We studied the effects of Robotic-Assisted Locomotor (LOKOMAT) Training on neuromuscular properties and muscle strength of the spastic ankle in persons with incomplete Spinal Cord Injury (SCI). LOKOMAT training was performed 3 days/week during a 1-hr period including set-up time. The training was provided for 4 weeks and subjects were evaluated before and after 1, 2, and 4 weeks of training. A system identification technique was used to quantify the effects of LOKOMAT training on neuromuscular abnormalities. The effect of LOKOMAT training on muscle strength was determined by measuring isometric maximum voluntary contraction (MVC) of ankle extensor and flexor muscles. Our results indicated that the reflex stiffness, abnormally increases in SCI, was significantly reduced (up to 65%) following 4-weeks of LOKOMAT training. Similarly, intrinsic (muscular) stiffness, which also abnormally increases in SCI, decreased significantly (up to 60%). MVCs were increased substantially (up to 93% in extensors and 180% in flexors) following 4-week training. These findings demonstrate that LOKOMAT training is effective in reducing spasticity and improving muscle strength in SCI.

The effect of robot-assisted lokomotor training on gait recovery: a multivariate analysis

To explore the effect of LOKOMAT and LOKOMAT+Tizanidine on the improvement of walking capacity for people with spinal cord injury (SCI), 20 SCI subjects with hypertonia spasticity at their ankle joints participated in a 12-session Lokomat training; among them, 10 subjects received Tizanidine. 1-hour LOKOMAT training was provided 3 times per week for 4-weeks. Subjects were evaluated 4 times for Timed-Up-and-Go, 10-Meter-Walking, and 6-Minute-Walking testings, at the baseline, 1-, 2- and 4-weeks after training. Latent Class Growth model was used to classify the LOKOMAT training speed, and clinical walking evaluations. Subjects in each treatment group could be classified into two subclasses for training speed and clinical evaluation. It was found that the training speed increased in all treatment group, while the subjects in LOKOMAT+Tizanidine presented a significant improvement of their training speed from the training session. The clinical evaluations classified subjects similarly, and no significant improvement of clinical measurements was observed for either treatment. The MVC dorsiflexion torque at the ankle joint was able to predict the class memberships of subjects for their walking capacity and can be used as a significant predictor for therapeutic functional recovery after spinal cord injury.

The centrality of community dynamics in the socio-economic recovery of devastated communities

OBJECTIVE

To assess and explore the health and socio-economic outcomes of Jubilee, a community on the Caribbean island of Grenada hit by Hurricane Ivan in 2004 and to identify remaining barriers to recovery.

METHODS

The assessment consisted of a mixed methods approach employing observations, household surveys, in-depth interviews and focus groups.

RESULTS

Eighty-five per cent of the residents live in a single-family home type dwelling which is occupied by multiple families. Twenty-seven per cent of the respondents depended on a river or stream for water and 83% utilized an outdoor pit latrine. Construction accounted for 28% of the employment while 16% reported having no occupation. Public and private transportation was limited and 48% of the residents lived on less than one United States of America (US) dollar per day. Access to healthcare was reported by 89% and the prevalence of diabetes and hypertension was identified by 13% and 30% of the residents respectively. Social fragmentation within the community represents a barrier that keeps the community from developing common goals leading to full economic recovery.

CONCLUSION

Jubilee has not fully recovered from the effects of Hurricane Ivan, but progress has been made in the reconstruction effort. These efforts have addressed the most immediate and basic needs of the community, mainly utility service infrastructure and home repairs. However issues related to the community's economic recovery are still unresolved.

Conserved epitopes in the protein tyrosine phosphatase family of diabetes autoantigens

IA2 and phogrin are important targets of humoral and cell-mediated autoimmunity in type 1 diabetes in man. They belong to a conserved subfamily of transmembrane protein tyrosine phosphatases (PTPs) associated with the regulatory pathway of secretion. To examine potential cross-reactivity between PTP family members we tested sera from T1D patients for reactivity to IA2, and the Drosophila (FLYDA) and C. elegans (IDA) orthologs using radioimmunoprecipitation assays of (35)S Met-labeled in vitro translated products of the cytosolic domains of these proteins. Approximately 80% of sera reacted with at least one probe. Of these, 82.5% showed reactivity to human IA2, 74.1% to FLYDA, and 33.7% to IDA. The majority of sera that bound FLYDA and/or IDA also recognized IA2. This raises the possibility that in some cases reactivity to IA2 may have arisen by molecular mimicry.

Near lethal endometriosis and a massive (64 kg) endometrioma: case report and review of the literature

A 51-year-old morbidly obese, hypertensive, anemic, and amenorrheic female presented with anuria and respiratory symptoms. The patient had a distinctly massive abdomen with necrotic anterior abdominal wall, and laboratory findings revealed a leukocytosis, profound anemia, coagulopathy and renal failure. An abdominal sonogram showed a large, complex intra-abdominopelvic mass and ascites. At surgery, a massive, cystic left ovarian mass, 37 1 of ascitic/cyst fluid, and several peritoneal nodules were removed--a total of 64 kg of tumorous tissue. Histopathological evaluation of the mass revealed an endometrioma. We present this rare case of severe endometriosis in a morbidly obese patient who presented with an exceptionally large endometrioma (64 kg), multifactorial respiratory and renal failure, coagulopathy, and profound anemia.

Phase II study of bevacizumab in combination with docetaxel and radiation in locally advanced squamous cell cancer of the head and neck (SCCHN)

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Background: VEGF expression has been shown to be up regulated in SCCHN, representing a promising therapeutic target. Bevacizumab is an anti-VEGF monoclonal antibody that may potentiate the efficacy of concurrent radiation and docetaxel. This trial represents the first attempt, to the best of our knowledge, to establish the efficacy and toxicities of the addition of bevacizumab to concurrent radiation with docetaxel in patients with locally advanced SCCHN. Methods: Patients with previously untreated stage III-IVb SCCHN receive standard once-daily radiation (70.2Gy, 1.8Gy/day), weekly docetaxel (20 mg/m2/week for the duration of radiation) and biweekly bevacizumab (5 mg/kg/two weeks) during and for up to one year following radiation. A total of 30 patients will be enrolled in this study. Results: Twelve of 30 planned patients (11 males), mean age 58 years (range 49–66), all with stage IV disease have been enrolled. Primary site: pharynx (n=8) and larynx (n=4). 10 patients have completed concurrent chemoradiation. After a median followup of 9 months (range: 0 –13), 9 patients remain in complete response, 1 patient developed metastatic disease. 6/10 patients underwent planned neck dissection and they all had a pathologic complete response. 6/9 patients, in complete response, are currently receiving adjuvant bevacizumab. The remaining 3 patients are currently off adjuvant bevacizumab treatment for area of radiation necrosis of larynx (n=1), pharyngoesophageal stenosis (n=1), status post cholecystectomy with pathology revealing acute hemorrhagic cholecystitis with transmural gangrenous necrosis (n=1). Conclusions: For patients with locally advanced SCCHN, preliminary data suggest that the addition of bevacizumab to concurrent radiation with docetaxel is feasible, safe and active. Supported in part by Genentech, NIH grants P30 CA43703 and M01 RR-000080 Clinicaltrials.gov identifier: NCT00281840

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Compassion or condemnation? South African Muslim students' attitudes to people with HIV/AIDS

Given the dearth of literature on the influence of religiosity on attitudes toward people with HIV/AIDS, the present study surveyed these variables in a sample of South African Muslim university students using the Religious Orientation Scale (ROS) and an attitude to people with HIV scale. Gender differences in attitudes towards people with HIV were also examined. The sample comprised 90 male and female undergraduate and postgraduate Muslim students. While both males and females displayed high religiosity scores, male students were found to be significantly more religious than female students. No gender differences were found on the attitude to people with HIV scale, with students indicating positive attitudes to people with HIV. Higher religiosity was significantly correlated with a more positive attitude to people with HIV. The implications of the findings are discussed.

Accelerated NaCl-induced hypertension in taurine-deficient rat: Role of renal function

Taurine modulates blood pressure and renal function. As the kidney plays a pivotal role in long-term control of arterial pressure, we tested the hypothesis that taurine-deficient rats display maladaptive renal and blood pressure responses to uninephrectomy. Control and taurine-deficient (i.e., beta-alanine-treated) rats with either one or two remaining kidneys were fed diets containing basal or high (8%) NaCl diet. Urine osmolality was greater in the taurine-deficient than controls fed a normal NaCl diet; proteinuria and blood pressure were unaffected by uninephrectomy. Following 6 weeks on an 8% NaCl diet, the uninephrectomized (UNX) animals developed significant hypertension, which was more severe in the taurine-deficient group; baroreflex function was unaffected. However, the UNX taurine-deficient rats displayed impaired ability to dispose of an acute isotonic saline volume load before a switchover to a high NaCl diet. Nonetheless, a more protracted exposure (i.e., 14 weeks) to dietary NaCl excess eliminated the blood pressure differential between the two groups; at this stage, renal excretory responses to an acute saline volume load or to atrial natriuretic peptide were similar in the two groups. Nonetheless, hypertensive taurine-deficient rats displayed greater proteinuria, although both groups excreted proteins of similar molecular weights ( approximately 15-66 kDa). Further, taurine-deficient kidney specimens displayed periarterial mononuclear cell infiltrates with strong immunoreactivity to the histiocyte marker CD68, suggestive of increased phagocytic activity. In conclusion, taurine deficiency modulates renal adaptation to combined uninephrectomy and dietary NaCl excess, resulting in an accelerated development of hypertension.

Comparison of 2 doses of daunorubicin(45mg/m2 vs 60mg/m2) in induction therapy of patients of de novo acute myeloid leukemia

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Background: Standard induction regimen for the management of acute myeloid leukemia (AML) includes 45 mg/m2 of daunorubicin (DNR) × 3 days and 100 mg/m2 of ara-c × 7 days. Recent studies suggest that higher doses of DNR may have better outcome. Randomized studies to objectively authenticate these observations to the best of our knowledge are not available. This study was undertaken as a preliminary trial to compare the induction remission rates and toxicity of 60 mg/m2 of DNR with standard dose of 45 mg/m2. Methods: Sixty newly diagnosed AML patients, except AML—M3, from January 2003—May 2005 were randomized to either 45mg/m2 (group A ) or 60 mg/m2 (group B) of DNR for three days. The dose of ara-c was 100mg/m2 for 7 days in both groups. All denovo AML patients with 0–2 performance status (ECOG) were included in the study. Results: Fifty six patients were evaluable, 30 in group A and 26 in group B. The baseline demographic and clinical characteristics were comparable. Twenty (67%) patients in group A and 23 (88%) in group B (p=0.05) achieved complete remission (CR). Fifteen (50%) patients in group A and 22 (84.6%) in group B (p=0.006) achieved remission after single course of induction chemotherapy. Nine patients (30%) in group A and 3 (11.5%) in group B died due to uncontrolled sepsis (p=0.09). Five patients, all belonging to Group A, had persistent disease at the time of death. Though there was no significant difference with respect to major organ toxicities in both the groups, duration of grade 4 thrombocytopenia and duration of admission were significantly greater in group A (P=0.02 and P=0.005 respectively). Conclusions: This study indicates that daunorubicin in the dose of 60 mg/m2 is superior to 45mg/m2 as a remission induction therapy for AML patients with good performance status. Further follow up is required to ascertain whether higher remission rate leads to higher disease free and over all survival.

No significant financial relationships to disclose.