Electrostimulation for promoting recovery of movement or functional ability after stroke

BACKGROUND

Electrostimulation might improve motor recovery after stroke by providing neuromuscular re-training.

OBJECTIVES

To find if electrostimulation improved functional motor ability, and the ability to undertake activities of daily living.

SEARCH STRATEGY

We searched the Cochrane Stroke Group Trials Register (last searched August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), CINAHL (1982 to January 2004), AMED - Allied and Complementary Medicine Database (1985 to January 2004), Physiotherapy Evidence Database (PEDro), REHABDATA and the ISI Science Citation Index (1981 to 2003). We placed a request on the PHYSIO e-mail discussion list and contacted authors of relevant studies to elicit any unpublished or ongoing studies, searched the reference lists of included trials and contacted trialists.

SELECTION CRITERIA

Randomised controlled trials of electrostimulation delivered to the peripheral neuromuscular system which was designed to improve voluntary movement control, functional motor ability and activities of daily living.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data.

MAIN RESULTS

Of the 2077 references identified, 24 trials were included in this review. For electrostimulation compared with no treatment this review found that electrostimulation improved some aspects of functional motor ability and some aspects of motor impairment and normality of movement. In addition, there was a significant difference in favour of no treatment compared with electrostimulation for an aspect of functional motor ability. For electrostimulation compared with placebo this review found that electrostimulation improved an aspect of functional motor ability. For electrostimulation compared with conventional physical therapy this review found that electrostimulation improved an aspect of motor impairment. There were no statistically significant differences between electrostimulation and control treatment for all other outcomes. However, these results need to be interpreted with reference to the following: (1) the majority of analyses only contained one trial; (2) variation was found between included trials in time after stroke, level of functional deficit, and dose of electrostimulation; and (3) the possibility of selection and detection bias in the majority of included trials.

AUTHORS' CONCLUSIONS

At present, there are insufficient robust data to inform clinical use of electrostimulation for neuromuscular re-training. Research is needed to address specific questions about the type of electrostimulation that might be most effective, in what dose and at what time after stroke.

Innovations and Challenges in Melanoma: Summary Statement from the First Cambridge Conference

Innovations and Challenges in Melanoma, chaired by Michael Atkins and cochaired by Ulrich Keilholz, John Kirkwood, and Jeffrey Sosman, was held July 15 to 16, 2005, in Cambridge, Massachusetts. The conference brought together leading experts in the fields of cancer research, medical oncology, surgical oncology, anatomic pathology, dermatology, and immunotherapy who wished to advance the field of melanoma treatment by exchanging information and perspectives regarding recent advances and recommendations for further study. The conference proceedings published in this educational supplement to Clinical Cancer Research are intended to provide timely information and recommendations on how genetics, biology, and data information can enhance our understanding of melanoma biology and help inform the use of therapies for this disease.

The benefits of frequent positive affect: does happiness lead to success?

Numerous studies show that happy individuals are successful across multiple life domains, including marriage, friendship, income, work performance, and health. The authors suggest a conceptual model to account for these findings, arguing that the happiness-success link exists not only because success makes people happy, but also because positive affect engenders success. Three classes of evidence--crosssectional, longitudinal, and experimental--are documented to test their model. Relevant studies are described and their effect sizes combined meta-analytically. The results reveal that happiness is associated with and precedes numerous successful outcomes, as well as behaviors paralleling success. Furthermore, the evidence suggests that positive affect--the hallmark of well-being--may be the cause of many of the desirable characteristics, resources, and successes correlated with happiness. Limitations, empirical issues, and important future research questions are discussed.

Iron deficiency anaemia in Jamaican children, aged 1-5 years, with sickle cell disease

OBJECTIVE

The aim of this study was to determine, using a combination of measures, the prevalence of iron deficiency anaemia (IDA) in children under five years-of-age who have sickle cell disease (SCD) and attend the Sickle Cell Clinic (SCU) of the Tropical Medicine Research Institute.

MATERIALS AND METHODS

Children with homozygous sickle cell anaemia (Hb SS) or doubly heterozygous for Hb S and Hb C (Hb SC) disease who had not received a blood transfusion within three months prior to the iron measurements, were enrolled. The diagnosis of IDA was made if transferrin saturation was less than 16% with serum iron less than 10.7 micromol/l and a low mean corpuscular volume (MCV) for age.

RESULTS

Twelve children (8.5%), seven with Hb SS and five with Hb SC had IDA. Adjusting for genotype, children with IDA had significantly higher red blood cell (RBC) counts (4.3 x10(9)/l vs 3.0 x 10(9)/l, p < 0.001) and total iron binding capacity (TIBC) (65.6 micromol/l vs 55.2 micromol/l, p < 0.004) but significantly lower reticulocyte (retic) counts (7.8 % vs 12.2%, p = 0.001) than children without IDA.

CONCLUSION

Iron deficiency anaemia is a clinical problem which affects children with SCD in Jamaica. The higher RBC counts in the IDA group may be due to decreased haemolysis and increased red cell survival whilst the lower reticulocyte counts may be due to impaired erythropoiesis. These observations need to be extended by clinical studies to establish improved diagnostic measures for IDA in SCD. Additionally, clinical trials are needed to determine whether treatment of IDA in children with SCD reduces morbidity and is associated with clinical benefits such as improvements in neurocognitive function.

The attack of the clones: tracking the movement of insecticide-resistant peach-potato aphids Myzus persicae (Hemiptera: Aphididae)

Myzus persicae (Sulzer) collected in Scotland were characterized for four microsatellite loci, intergenic spacer fingerprints and the resistance mechanisms modified acetylcholinesterase (MACE), overproduced carboxylesterase and knockdown resistance (kdr). Microsatellite polymorphisms were used to define a limited number of clones that were either fully susceptible to insecticides or possessed characteristic combinations of resistance mechanisms. Within these clones, intergenic spacer fingerprints could either be very consistent or variable, with the latter indicating ongoing evolution within lineages, most likely derived from the same zygote. Two clones (termed A and B) possessed all three resistance mechanisms and predominated at sites treated with insecticides. Their appearance on seed potatoes and oilseed rape in Scotland in 2001 coincided with extensive insecticide use and severe control failures. Clones C, I and J, with no or fewer resistance mechanisms, were found in samples from 1995 and were dominant at untreated sites in 2001. A comparison of Scottish collections with those from other UK and non-UK sites provides insight into the likely origins, distribution and dynamics of M. persicae clones in a region where asexual (anholocyclic) reproduction predominates, but is vulnerable to migration by novel genotypes from areas of Europe where sexual (holocyclic) reproduction occurs.

Evaluation of peer review of infection control arrangements for healthcare-associated infection in four acute care trusts in the East of England

In order to constructively use Department of Health surveillance data to address the issue of healthcare-associated infection, a peer review process investigating infection control arrangements for healthcare-associated infection in acute care trusts was initiated in the East of England. This study set out to evaluate that process and determine if it should be rolled out regionwide. A questionnaire survey of infection control doctors at trusts visited was conducted by telephone. Respondents commented that the peer review process raised the profile of infection control and healthcare-associated infection in participating trusts, and that a review of routine surveillance data was a useful way to initiate discussion about and focus attention on hospital infection control. Respondents felt the forum for discussion of infection control was most beneficial. A peer review process utilising routine surveillance data is of value in addressing issues related to infection control arrangements for healthcare-associated infection in acute care trusts.

Lymphocyte subpopulations from patients with primary antibody deficiency do not show increased telomere erosion

Telomere erosion and residual replicative capacity can be used as markers of the replicative history of somatic cells. We have investigated telomere length, in vitro replicative capacity and rate of telomere erosion in T and B lymphocyte populations from patients with primary antibody deficiency requiring immunoglobulin replacement therapy. We found no significant differences in telomere lengths of B cells, or of CD4+, CD8+, CD45RA+ (naive) and CD45RO+ (memory) T cell populations between patients and age matched controls. Overall, telomere length correlated inversely with age, and was reduced in memory (CD45RO+) as compared with naive (CD45RA+) T cells. In vitro long-term (6 months) cell cultures showed no differences between patients and controls in the mitogen-stimulated replicative potential of T cell subpopulations (CD4+, CD8+, CD45RA+, CD45RO+), or in the rates of telomere erosion with cellular replication in these cell populations. The rate of telomere erosion per population doubling in CD45RA+ cells, however, was greater than in CD45RO+ cells in both patients and controls. These data suggest that premature immune exhaustion is unlikely to represent a long-term complication of primary antibody deficiency.

Receptor Interactions Involved in Adenoviral-Mediated Gene Delivery After Systemic Administration in Non-Human Primates

Adenovirus serotype 5 (Ad5)-based vectors can bind at least three separate cell surface receptors for efficient cell entry: the coxsackie-adenovirus receptor (CAR), alpha nu integrins, and heparan sulfate glycosaminoglycans (HSG). To address the role of each receptor involved in adenoviral cell entry, we mutated critical amino acids in fiber or penton to inhibit receptor interaction. A series of five adenoviral vectors was prepared and the biodistribution of each was previously characterized in mice. To evaluate possible species differences in Ad vector tropism, we characterized the effects of each detargeting mutation in non-human primates after systemic delivery to confirm our conclusions made in mice. In non-human primates, CAR was found to have minimal effects on vector delivery to all organs examined including liver and spleen. Cell-surface alpha nu integrins played a significant role in delivery of vector to the spleen, lung and kidney. The fiber shaft mutation S*, which presumably inhibits HSG binding, was found to significantly decrease delivery to all organs examined. The ability to detarget the liver corresponded with decreased elevations in liver serum enzymes (aspartate transferase [AST] and alanine transferase [ALT]) 24 hr after vector administration and also in serum interleukin (IL)-6 levels 6 hr after vector administration. The biodistribution data generated in cynomolgus monkeys correspond with those data derived from mice, demonstrating that CAR binding is not the major determinant of viral tropism in vivo. Vectors containing the fiber shaft modification may provide for a detargeted adenoviral vector on which to introduce new tropisms for the development of targeted, systemically deliverable adenoviral vectors for human clinical application.

Evaluation of the duration of human factor VIII expression in nonhuman primates after systemic delivery of an adenoviral vector

An E1/E2a/E3-deficient adenoviral vector encoding an epitope-tagged (flagged) human factor VIII (FVIII) cDNA was delivered systemically to four cynomolgus monkeys. Analysis of liver biopsy samples revealed the presence of vector DNA at all points in the study (day 7, 28, and 56), with vector copy number declining approximately 10-fold between day 7 and day 56. Immunoprecipitation/Western analyses detected human flagged FVIII in the plasma of all monkeys and expression persisted for 14-28 days. Peak plasma FVIII levels ranged from 50 to 100 ng/ml. Bethesda assays revealed no inhibitor in two animals, the development of a low-level transient inhibitor in one animal, and an inhibitor titer that continued to increase for the duration of the study in one animal. Other treatment-related changes included modest increases in liver enzymes, an increase in interleukin-6 (IL-6) levels, and a transient decrease in platelets in all four animals. These data indicate that early generation adenoviral vectors do not support the long-term expression of FVIII in nonhuman primates.