Rehabilitation efficiency and destination on discharge after stroke

BACKGROUND

Predicting functional recovery of patients is key for setting the objectives of the rehabilitation programme and making decisions on their destination on discharge. Many variables have an impact on disability and quality of life after stroke, including patient age, comorbidity, severity of neurological deficit, state of mind and social risk. Accordingly, it is also essential from a care perspective to optimise the functional recovery and efficiency of rehabilitation programmes, exploring their relationship with these variables.

AIM

To analyze the efficiency of post-stroke rehabilitation, identifying factors that most strongly influence functional recovery and destination on discharge.

DESIGN

Multicentre prospective cohort study

SETTING/POPULATION

All patients admitted to the Rehabilitation Units of the two hospitals after stroke over eight months

METHODS

Collected data on sociodemographic characteristics, social risk (Gijón Scale), comorbidity (Charlson Index), neurological severity (National Institute of Health Stroke Scale), daily living functioning scale (Barthel Index), length of hospital stay and destination on discharge.

RESULTS

We included 241 patients, with a mean stay of 35±22 days, 81.5% returning home on discharge. On admission 45.2% were totally dependent, and this figure fell to 12.8% on discharge, the mean Barthel Index score increasing by 32.5 points. Neurological severity, hemiparetic severity, impairment of deep sensation and trunk control on admission were the mayor variables influence on rehabilitation efficiency (P<0.001). Destination on discharge was most closely associated with civil status, social risk and Barthel Index score (P<0.001). The likelihood of transferring to residential care is 3- and 2.71-fold higher among patients with total dependence and high comorbidity scores, respectively.

CONCLUSION

Many variables influence on outcomes of stroke inpatient rehabilitation.

CLINICAL REHABILITATION IMPACT

Comprehensive assessments are required to predict patient recovery, efficiency and plan for discharge.

Vaginal lactoferrin in asymptomatic patients at low risk for pre-term labour for shortened cervix: cervical length and interleukin-6 changes

A total of 3,324 singleton pregnant women were screened for pre-term delivery and 128 women were finally randomised and analysed for outcome showing borderline cervical length (25-29 mm) and elevated cervico-vaginal interleukin 6 levels. To verify if vaginal administration of lactoferrin might have an influence on these variables, two groups of 64 patients were formed. Study cases were submitted to lactoferrin for 21 days; controls received no treatment. An inverse relation was found between interleukin 6 levels and cervical length. On day 30 from the beginning of the treatment, study cases showed a decrease in interleukin 6 levels and an increase in cervical length. A greater number of women with regular uterine contractions and reduced cervical consistency before the 37th week of gestation were found in the controls. Our data show that lactoferrin could play a role in reducing the number of women at risk for pre-term birth for shortened cervical length and elevated interleukin 6 levels.

Attosecond pulse walk-off in high-order harmonic generation

We study the influence of the generation conditions on the group delay of attosecond pulses in high-order harmonic generation in gases. The group delay relative to the fundamental field is found to decrease with increasing gas pressure in the generation cell, reflecting a temporal walk-off due to the dispersive properties of the nonlinear medium. This effect is well reproduced using an on-axis phase-matching model of high-order harmonic generation in an absorbing gas.

A high spatial resolution outdoor dose rate map of the Rio de Janeiro city, Brasil, risk assessment and urbanization effects

Geophysical surveys have been widely used for geological mapping, and with appropriate ground calibration the database can be converted to radiometric surveys. Herein we present a case study of a high resolution map of the City of Rio de Janeiro, Brazil, constructed by integrating aerial and in situ (ground) measurements. This allowed assessing the influence of urbanization observed between 1978 and 2009 on radiation external exposure. Radiometric, geological and demographics databases were integrated in a Geographic Information System (GIS) facility. The average absorbed dose rate recorded for the city was 96 ± 0.3 nGy h(-1) and ranged from 22 to 152 nGy h(-1) among districts. The corresponding annual effective dose was determined as 0.09 ± 0.01 mSv. The number of people at risk per year according to the estimated natural radiation levels was 17 ± 1.4, among the 28,000 new cases estimated by the INCA (Brazilian National Cancer Institute) within a population of approximately 6.3 million people.

Resilience and brain connectivity

A definition of resilience is the capacity to resist mental disorders despite exposure to stress. Little is known about its biological concomitants. In adults, biochemical and hormonal factors have been advocated. Smaller Corpus Callosum (CC) volume and lower Fractional Anisotropy (FA) have been observed in psychiatric and stress-related conditions. There is no Diffusion Tensor Imaging (DTI) study of resilience in adolescence, a critical lifetime period for neural and psychological maturation. We hypothesized that higher FA in the CC would characterize stress-resilient adolescents.

Methods

Three community groups were compared: resilient adolescents – with low risk of mental disorder despite high exposure to lifetime stress, adolescents at risk of mental disorder exposed to the same level of stress, and controls. Personality was assessed by NEO Five Factor Inventory (NEO-FFI) and cognitive function by a battery of tests. Voxelwise statistics of DTI values in CC were obtained using Tract-Based Spatial Statistic. Regional projections were identified by probabilistic tractography.

results

Higher FA values were detected in the anterior CC of resilient compared with both non-resilient and control adolescents. FA values varied according to resilience capacity. Regional changes in CC were in regions that project onto anterior cingulated and frontal cortex. Neuroticism and three other personality factors differentiated at risk adolescents from the other two groups.

Conclusion

High FA was detected in resilient adolescents in an anterior CC region projecting to frontal areas subserving cognitive resources. Psychiatric risk in adolescents was associated with personality characteristics. Resilience in adolescence may be a dimension embedding white matter features.

Probing time-dependent molecular dipoles on the attosecond time scale

Photoinduced molecular processes start with the interaction of the instantaneous electric field of the incident light with the electronic degrees of freedom. This early attosecond electronic motion impacts the fate of the photoinduced reactions. We report the first observation of attosecond time scale electron dynamics in a series of small- and medium-sized neutral molecules (N(2), CO(2), and C(2)H(4)), monitoring time-dependent variations of the parent molecular ion yield in the ionization by an attosecond pulse, and thereby probing the time-dependent dipole induced by a moderately strong near-infrared laser field. This approach can be generalized to other molecular species and may be regarded as a first example of molecular attosecond Stark spectroscopy.

Lipoic acid lessens Th1-mediated inflammation in lipopolysaccharide-induced uveitis reducing selectively Th1 lymphocytes-related cytokines release

Inflammation results in the production of free radicals. We evaluated the anti-inflammatory and antioxidant capacity of lipoic acid in an experimental uveitis model upon a subcutaneous injection of endotoxin into Lewis rats. The role of oxidative stress in the endotoxin-induced uveitis model is well-known. Besides, the Th1 response classically performs a central part in the immunopathological process of experimental autoimmune uveitis. Exogenous sources of lipoic acid have been shown to exhibit antioxidant and anti-inflammatory properties. Our results show that lipoic acid treatment plays a preventive role in endotoxin-induced oxidative stress at 24 h post-administration and reduced Th1 lymphocytes-related cytokines by approximately 50-60%. Simultaneously, lipoic acid treatment caused a significant reduction in uveal histopathological grading and in the protein concentration in aqueous humors, but not in cellular infiltration.

Abstract P6-10-06: Rational combination therapy against triple-negative breast cancer

Background: Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer with higher incidence of recurrence, more distant metastasis, and poorer survival. This subtype is also characterized by complex genomes where little of their genomes remain at normal copy number but without high, focal copy number amplifications. At the transciptome level, the majority of TNBC (∼75%) are classified as basal-like breast cancer (BLBC) according to the five intrinsic subtypes. Despite considerable genomic and gene expression characterization of TNBC, proteomic and phospho-proteomic investigations of this disease are limited with no available targeted therapies in clinical use.

Methods & Results: We used the Kinex™ antibody array (http://www.kinexus.ca/) to interrogate protein/phosphoproteins levels in 43 primary breast cancer biopsies (16 TNBC, 16 ER/PR positive and 11 HER2-positive) and 16 breast cancer cell lines. Unsupervised hierarchical clustering of protein/phosphoprotein levels revealed two subgroups of TNBC in comparison to other subtypes. Western blotting and Proteome Profiler™ Arrays (R&D Systems) were used to validate deregulated proteins/phosphoproteins in TNBC. Pathway analysis revealed that one subgroup of TNBC exploits overlapping and cross-talking networks for survival. These signaling networks are downstream from elevated activation of EGFR, integrins and Insulin-like growth factor 1 receptor (IGF1R).

Targeted molecular inhibitors of activated kinases in these pathways showed specificity against basal-like/TNBC cell lines compared to other subtypes in vitro. These activated kinases/networks represent druggable targets for the treatment of TNBC but may be limited by compensatory effect of the complex cross-talking signaling networks.

To overcome compensatory downstream signaling that would limit the inhibition of a given pathway; we developed EGFR-targeted radioimmunotherapy (RIT) strategy to systemically deliver cytotoxic loads of beta particles (177Lu) that would kill targeted cells and surrounding cells by crossfire effect. The combination of EGFR-directed RIT with chemotherapy and PARP inhibition successfully treated orthotopic and metastatic TNBC models established from cell lines and patient-derived xenografts. The superior efficacy of this triple-agent combination therapy is explained by enhanced DNA damage and reduced DNA repair response, higher apoptotic cell death and the elimination of putative breast cancer stem cells.

Conclusion: Proteomic analysis of TNBC provides a powerful tool to elucidate druggable signaling networks with therapeutic potential. TNBC utilizes complex interacting signaling networks and rational combination therapies are required for effective therapy.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-10-06.

[Stability of the antioxidant capacity and pH of human milk refrigerated for 72 hours: longitudinal study]

Maternal milk is the optimal feeding way for the infant at least for the first six months of life. Its properties include nutrients intake and, particularly, to provide the infant with several beneficial compounds improving his growth and protecting him from the diseases typical of this time period. These properties justify the manipulating processes before its intake in order to promote and warrant the adherence to it, both at the hospital and at home, being more important in premature infants and/or with low birth weight given their increased vulnerability, is spite of the fact that during these processes some of its properties may be partially lost. There exist, therefore, an interest in knowing the impact of the procedures applied to human milk on its qualitative properties, such as the antioxidant capacity.

OBJECTIVE

This work assesses the stability of the antioxidant capacity of human milk during its storage at 4º C, longitudinally from its extraction until 48 h of refrigeration, as well as the pH changes.

METHOD

the milk from 30 healthy women was analyzed. The milk's antioxidant capacity was assessed by the following parameters: total antioxidant capacity and level of malondialdehyde. The results obtained showed that pH decreases gradually from the storage beginning, whereas the antioxidant capacity remains constant for the first 24 hours, with a different result depending on the parameter used, and thereafter significant changes were observed.

CONCLUSIONS

In case of needing extraction and storage of maternal milk before its consumption, the storage time should be minimized, preferably less than 24 hours in order to preserve the oxidative stress.

High-speed carrier-envelope phase drift detection of amplified laser pulses

An instrument for measuring carrier-envelope phase (CEP) drift of amplified femtosecond laser pulses at repetition rates up to the 100-kHz regime is presented. The device can be used for real-time pulse labeling and it could also enable single-loop CEP control of future high-repetition rate laser amplifiers. The scheme is demonstrated by measuring the CEP drift of a 1-kHz source.

Serum metabolite concentrations and enzyme activities in finishing bull calves fed different types of high-grain diets

Abstract. Between the ages of 23 and 35 weeks, various serum metabolites and enzymes were monitored in three 10-animal groups of double-muscled Belgian Blue bull calves maintained in a feedlot in Galicia (NW Spain) on high-grain finishing diets that mainly differed in whether the grain used was predominantly maize (group M), predominantly barley (group B), or a mixture of maize and barley in approximately equal proportions (group MB). The parameters determined were glucose, non-esterified fatty acids (NEFA), total serum protein concentration (TSP), albumin, serum urea nitrogen (SUN), creatinine, aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). Throughout the study period, all these parameters remained within the physiological ranges for beef under intensive conditions, and no animal ever showed clinical symptoms of ruminal alterations; indicating that none of these highgrain diets were detrimental to animal health. Although average serum NEFA, creatinine, albumin, AST and GGT levels all differed among groups, only AST can be considered as possible age-independent marker of grain-type-related metabolic alterations, since the other parameters all showed significant time × group interaction. In terms of this parameter, animals fed a MB diet behaved similarly to those fed a B diet. The absence of between-group differences in blood glucose level may reflect a genetic characteristic of this double-muscled breed. Our results, in conjunction with the best productive results obtained in animals fed de B-diet, aim us to suggest that the risk of an acidogenic diet would depend strongly on the nutritional management (in terms of crude protein (CP) and quality of straw in the ration) and not only the type of grain.

Feeding dystonia in McLeod syndrome

BACKGROUND

The X-linked McLeod syndrome belongs to the group of neuroacanthocytosis syndromes and has a Huntington-disease-like phenotype with a choreatic movement disorder, cognitive alterations, and psychiatric symptoms. Another neuroacanthocytosis syndrome, the autosomal recessive chorea-acanthocytosis, has a similar presentation, but distinct clinical features, believed to be characteristic, such as tongue protrusion dystonia, feeding dystonia, and rubber-man-like appearance.

METHODS

This work comprised a case series of 3 patients with McLeod syndrome.

RESULTS

The 3 patients with McLeod syndrome developed severe feeding dystonia and tongue protrusion as well as rubber-man-like appearance in 1 patient during the course of the disease.

CONCLUSION

These observations indicate that there is an extended phenotypic overlap between McLeod syndrome and chorea-acanthocytosis.