Topical Cellular/Tissue and Molecular Aspects Regarding Nonpharmacological Interventions in Alzheimer's Disease-A Systematic Review

One of the most complex and challenging developments at the beginning of the third millennium is the alarming increase in demographic aging, mainly-but not exclusively-affecting developed countries. This reality results in one of the harsh medical, social, and economic consequences: the continuously increasing number of people with dementia, including Alzheimer's disease (AD), which accounts for up to 80% of all such types of pathology. Its large and progressive disabling potential, which eventually leads to death, therefore represents an important public health matter, especially because there is no known cure for this disease. Consequently, periodic reappraisals of different therapeutic possibilities are necessary. For this purpose, we conducted this systematic literature review investigating nonpharmacological interventions for AD, including their currently known cellular and molecular action bases. This endeavor was based on the PRISMA method, by which we selected 116 eligible articles published during the last year. Because of the unfortunate lack of effective treatments for AD, it is necessary to enhance efforts toward identifying and improving various therapeutic and rehabilitative approaches, as well as related prophylactic measures.

Favorable outcomes within a comprehensive therapeutic rehabilitative program in a complex case of severe polytrauma

A polytrauma patient after a car accident represents a challenge for the health care system due to the multiple traumatic injuries, at least one of them potentially being life threatening. Many of these injuries require intense nursing and rehabilitation treatment, because some of them can cause permanent disability, affecting the patient’s future quality of life. Materials and methods: With the permission of the THEBA Ethics Committee (no 24389 / 28.06.2021), this paper presents a case of a 37-year-old patient with a severe polytrauma due to a car accident (driver), occurred on October 18, 2020. The patient was hospitalized in the Intensive Care Unit of the Emergency County Hospital of Targoviste, in a severe condition, being orotracheal intubated and having a thoracic polytrauma (multiple bilateral costal fractures, anterior-superior flail chest with acute respiratory failure) and mandible fracture. After clinical and hemodynamic stabilization, he was transferred to Bucharest Emergency University Hospital and after specific paraclinical investigations, he was surgically treated with thoracic fixation with metal plates, sternal fixation with plate and screws, thoraco-abdominal skin grafting and mandibular stabilization. Afterwards he was transferred to THEBA at the Plastic Surgery Clinic Department for lumbar-sacral pressure sore, where he suffered multiple surgical interventions. In our Neuromuscular Rehabilitation Department, the patient was admitted in 16.02.2021 with pain and severe functional impairments in the right elbow and the right knee, surgically treated sacral pressure sore still in the process of healing and having a severe deficiency of self-care and locomotion. He initially followed a rehabilitative nursing program and continued with a recovery therapy according to clinical stages. The patient was functionally assessed using the following scales: Medical Research Council (MRC) Scale for Muscle Strength, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale and Independence Assessment Scale in Daily Activities (ADL/IADL). Results: Although the patient's evolution was slow, he had favorable outcomes with an increase in the scores of the evaluated scales at discharge. He benefited from specific surgical care of the pressure sores and a complex neuro-muscular rehabilitative program. The patient’s final performance in our clinic was walking on medium distances with support from another person. Conclusion: The multidisciplinary team approach with the addition of complex nursing measures and a personalized rehabilitative program for a young patient with polytrauma caused by a car accident established neuro-locomotor improvements which led to an increase in patient’s quality of life. Keywords: neuro-muscular rehabilitation, polytrauma

Recent Advances in Molecular Research on Hydrogen Sulfide (H2S) Role in Diabetes Mellitus (DM)-A Systematic Review

Abundant experimental data suggest that hydrogen sulfide (H₂S) is related to the pathophysiology of Diabetes Mellitus (DM). Multiple molecular mechanisms, including receptors, membrane ion channels, signalingmolecules, enzymes, and transcription factors, are known to be responsible for the H₂S biological actions; however, H₂S is not fully documented as a gaseous signaling molecule interfering with DM and vascular-linked pathology. In recent decades, multiple approaches regarding therapeutic exploitation of H₂S have been identified, either based on H₂S exogenous apport or on its modulated endogenous biosynthesis. This paper aims to synthesize and systematize, as comprehensively as possible, the recent literature-related data regarding the therapeutic/rehabilitative role of H₂S in DM. This review was conducted following the “Preferred reporting items for systematic reviews and meta-analyses” (PRISMA) methodology, interrogating five international medically renowned databases by specific keyword combinations/“syntaxes” used contextually, over the last five years (2017–2021). The respective search/filtered and selection methodology we applied has identified, in the first step, 212 articles. After deploying the next specific quest steps, 51 unique published papers qualified for minute analysis resulted. To these bibliographic resources obtained through the PRISMA methodology, in order to have the best available information coverage, we added 86 papers that were freely found by a direct internet search. Finally, we selected for a connected meta-analysis eight relevant reports that included 1237 human subjects elicited from clinical trial registration platforms. Numerous H₂S releasing/stimulating compounds have been produced, some being used in experimental models. However, very few of them were further advanced in clinical studies, indicating that the development of H₂S as a therapeutic agent is still at the beginning.

Case report and related comments in a relatively young male patient with right hemiplegia after left thalamo- mesencephalic hemorrhage and a consequent Parinaud syndrome – interdisci-plinary therapeutic – rehabilitative approach

Thalamo- mesencephalic hemorrhage is a devasting event, with a increased morbidity and mor-tality rate. Parinaud’s syndrome, also known as the dorsal midbrain syndrome, is characterized by a supranuclear vertical gaze disturbing, resulting from an insult to the mesencephalic tectum. Matherial and Method. We report the case of a 45-year-old man with personal antecedents of ar-terial hypertension, obesity and type 2 Diabetus mellitus, who was first admitted in the Neuro-logy Clinic Division of the Teaching Emergency Hospital Bucharest with a sudden onset of com-plete right hemiplegia, mixed aphasia and right central– type facial palsy on 17.04.2021, being diagnosed – following complex paraclinic investigations -with a left thalamo- mesencephalic hemorrhage. Results and discusssion. The patient followed a neuro- muscular rehabilitation program in our Neuro- Rehabilitation Clinic Division with favorable outcomes, the case repre-senting a real challenge regarding the complexity of the factors involved. Conclusions. The cli-nical outcomes and the quality of life of patients suffering from thalamo- mesencephalic hemor-rhage depend both on the prompt diagnosis and the efficient treatment, followed by an appro-priate rehabilitation program. Keywords: neuro-rehabilitation, thalamo-mesencephalic hemorrhage, Parinaud syndrome

Successful rehabilitation program after AIS/Frankel C paraplegia through a recently operated lumbar disc hernia

Intervertebral disc herniation is the pathological process by which fragments of the nucleus pul-posus tear the fibers of the annulus fibrosus and come into contact with the root of the spinal nerve (1). The most significant functional damage generated by the lumbar disc herniation is paraplegia and can be ameliorated by an early and staged specific rehabilitation program. Materials and Methods: This paper presents the case of a 56-year-old patient who was admitted to the Neurosurgery Clinic (NCH) III of SCUBA for low back pain and motor deficit, AIS Frankel C paraplegia. The left lower limb was more affected than the right one. It occurred following a thoraco-lumbar medullary compression and a paramedian lumbar disc herniation L3. The pa-tient was treated surgically. Subsequently, the patient was transferred to the Neuro-Muscular Recovery Clinic of SCUBA for the specific rehabilitation treatment, with indication for mobiliza-tion. He was dynamically evaluated using the following scales: quality of life assessment (QOL), modified Ashworth scale, Functional Assessment Classification, FAC, Activities of daily living (ADL), Spinal Cord Independence Measure (SCIM), evaluation of muscle strength on Medical Re-search Council, MRC, scale, evaluation of American Spinal Injury Association Impairment Scale (AIS). Results: The patient benefited from a complex program of neuro-muscular rehabilitation, hav-ing a favorable evolution with an improving score of the evaluating scales and finally gaining his gait balance, including ascending and descending stairs (instrumentally assisted for left plan-tar dorsiflexion movement with orthosis walking). At discharge the patient’s neurological defi-cit was reclassified as AIS D paraplegia, with the neurogenic bladder and bowel having been remitted. Discussions: The disc herniation at L3 level generated a cauda equina syndrome, which initially generated a paraplegia. When the inflammation remitted it became clear that the left L4 root was affected, with a complete deficit of plantar dorsiflexion. In conclusion it was not a case of spinal cord syndrome (as the spinal cord ends at L2 level) or conus medullaris syndrome. Conclusions: The interdisciplinary therapeutic approach together with a specific, customized re-habilitation program for a patient with AIS C paraplegia after a surgically treated disc hernia is successfully improving the neuromuscular deficit and upgrading the patient's quality of life. Keywords: rehabilitation, disc hernia, low back pain, paraplegia

Radial Extracorporeal Shockwave Therapy versus Ultrasound Therapy in Adult Patients with Idiopathic Scoliosis

BACKGROUND

This study aimed to compare the effectiveness of radial extracorporeal shockwave and ultrasound therapies in adult patients with idiopathic scoliosis in terms of pain, disability, and quality of life.

METHODS

Forty-eight patients with idiopathic scoliosis were randomly divided into three groups of 16: shockwave, ultrasound, and control. The patients were evaluated at admission (day one) and at discharge (day 14) for pain, by using the visual analogue scale; for disability, by using the Oswestry disability index; and for the quality of life, with short form-36.

RESULTS

Radial extracorporeal shockwave therapy was more effective than ultrasound in reducing pain (p = 0.004) and increasing quality of life, bringing extra vitality (p = 0.003) and emotional comfort (p = 0.007) to the patient. Both shockwave therapy (p = 0.001) and ultrasound therapy (p = 0.003) were effective in reducing pain. In terms of disability, both treatments had similar effects (p = 0.439).

CONCLUSION

Radial shockwave was significantly more effective than ultrasound in reducing pain and increasing the quality of life, bringing additional vitality and emotional comfort to the patient with idiopathic scoliosis. In terms of disability, both treatments had similar effects when associated with kinesitherapy.

Mobile Mechatronic/Robotic Orthotic Devices to Assist-Rehabilitate Neuromotor Impairments in the Upper Limb: A Systematic and Synthetic Review

This paper overviews the state-of-the-art in upper limb robot-supported approaches, focusing on advancements in the related mechatronic devices for the patients' rehabilitation and/or assistance. Dedicated to the technical, comprehensively methodological and global effectiveness and improvement in this inter-disciplinary field of research, it includes information beyond the therapy administrated in clinical settings-but with no diminished safety requirements. Our systematic review, based on PRISMA guidelines, searched articles published between January 2001 and November 2017 from the following databases: Cochrane, Medline/PubMed, PMC, Elsevier, PEDro, and ISI Web of Knowledge/Science. Then we have applied a new innovative PEDro-inspired technique to classify the relevant articles. The article focuses on the main indications, current technologies, categories of intervention and outcome assessment modalities. It includes also, in tabular form, the main characteristics of the most relevant mobile (wearable and/or portable) mechatronic/robotic orthoses/exoskeletons prototype devices used to assist-rehabilitate neuromotor impairments in the upper limb.

Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic

The ankylosing spondylitis (AS) is a systemic, multi-factorial, chronic rheumatic disease. Patients are highly susceptible to vertebral fractures with or without spinal cord injury (AS-SCI), even after a minor trauma. The study is a retrospective descriptive survey of post-acute, traumatic AS-SCI patients, transferred from the neurosurgical department and admitted in a Romanian Neurorehabilitation Clinic, during 2010-2014. There were 11 males associating AS-SCI (0.90% of all consecutive SCI admitted cases), with an average age of 54.6 years (median 56, limits 42-73 years). The average duration between the medically diagnosed AS and the actual associated spinal fracture(-s) moment was 21.4 years (median 23; limits 10-34 years). Low-energy trauma was incriminated in 54.5% cases. The spinal level of fracture was: cervical (four cases), thoracic (three), lumbar (four), assessed at admission as: American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (four subjects), C (five) and D (two). By the time of discharge, neither patient has neurologically deteriorated; five patients (45.5%) improved of at least grade 1 (AIS). The overall complications were mainly infections: symptomatic urinary tract infections (seven patients; 63.6%), pulmonary (three subjects; 27.3%) and spondylodiscitis (one case; 9%). The average follow-up period was 15.3 months (median 12; limits 1-48 months) after discharge; three subjects gained functional improvement to AIS-E. The clinical profile (different risk factors, mechanisms, types and levels of spinal fractures, additional encephalic and/or cord lesions, co-morbidities), different post-surgical and/or general complications acquired during admission in our rehabilitation ward, served us for future prevention strategies and a better therapeutic management.

Preliminary results of using ALAnerv® in subacute motor incomplete paraplegics

RATIONALE

To assess whether using ALAnerv® contributes to improvements of outcomes obtained in post SCI patients.

OBJECTIVE

A prospective controlled clinical survey also to evaluate the safety and efficacy of ALAnerv® (2cps/ day for 28 days) in motor incomplete (AIS/ Frankel C) paraplegic subacute patients.

METHODS AND RESULTS

59 patients divided in study (treated with ALAnerv®) and control, groups. This survey's follow-up duration was of 28 days. Most of the studied patients were mid-aged (mean 43.75 years old) and respectively, men (64,29% in the study group; 58,06% in controls). We used descriptive statistics (functions: minimum, maximum, mean, median, standard deviation) and for related comparisons, parametric (Student t) and non-parametric (Mann-Whitney, Fisher's exact, chi-square) tests. The primary end-point: AIS motor values' evolution (P= 0.015 - Mann-Whitney), showed that patients treated with ALAnerv® - vs. controls - had a statistically significant better increase of such scores at discharge. Paraclinical parameters, mainly exploring systemic inflammatory status (secondary end-point): ESR dynamics (P=0.13) had no statistical significance; the plasma leucocytes number (P=0.018), the neutrophils' percentage (P=0.001) and fibrinogenemia (P= 0,017) proved in the treated group to have a statistically significant better evolution. We used "Statistical Package for Social Sciences" (SPSS).

DISCUSSION

As there is actually no effective curative solution for the devastating pathology following SCI, any medical approach susceptible to bring even limited improvements, such as treatment with ALAnerv® seemed to have proven, is worth being surveyed, under strict circumstances of ethics and research methodology. Considering the necessity for more statistical power concerning primary, secondary end-points, and safety issues, as well, continuing this research is needed.

ABBREVIATIONS

SCI = spinal cord injury, TSCI = traumatic spinal cord injury, BBB = blood brain barrier, CNS = central nervous system, SC = spinal cord, NSAIDs = non-steroidal anti-inflammatory drugs, SAIDs = steroidal anti-inflammatory drugs, AIS = American Spinal Injury Association Impairment Scale, SPSS = Statistical Package for Social Sciences, BATEH = Bagdasar-Arseni Teaching Emergency Hospital.

Assumptions and conceptual contributions to improve the global assistive performance of actual wheelchairs, in order to enhance the users' autonomy and quality of life

Rationale: Recovery of autonomy, in paralyzed/with severe disabilities patients, is one of the most difficult challenges for rehabilitation. Thus, an appropriate wheelchair is essential for this kind of people, both in daily lives, including work and social participation, and for quality of life (QoL). Objective: The purpose of the study is to achieve a consistent improvement to the actual models of wheelchairs followed by validation through clinical trial of the optimized prototype, in order to enhance the users' autonomy and QoL. Material and Results: In the research activities and for establishing constructive and optimized functional solutions will be used, simulation of system operation techniques, based on software packages and Computer-Aided Design/ Engineering (CAD/ CAE) systems. Validation, of the optimized wheelchair prototype, through clinical trial, requires a prospective study. The study will include a group of 30 patients, who will be investigated for a one-month period. The patients will complete, at the end of the study, a standardized questionnaire containing generic data and many items referring to the optimized wheelchair functions and to the autonomy of the users including in relation to their own expectations. We will also use the quantified evaluation scale of QoL, Wheelchair Outcome Measure (WhOM) and a Falls Concern Scale for people with Spinal Cord Injury (SCI-FCS). Discussion: The wheelchair particularities that we pursue, and which are distinguished from the other models, is the fact that the wheelchair is powered, pliable and allows verticalization, hopefully at a price comparable or even lower than the current state of the art models (but none of them succeeded by now to fulfil all this three basic functions on a single "all in one" such device). Hence, if our optimized prototype will achieve technical and clinical validation, this will result in a significant enhancement of autonomy and QoL for the users.

Neuroprotective and consequent neurorehabilitative clinical outcomes, in patients treated with the pleiotropic drug cerebrolysin

BACKGROUND

Discovery of neurotrophic factors--emblematic: the nerve growth factor (NGF)--resulted in better approaching central nervous system (CNS) lesions. Recently, another crucial property has been unveiled: their rather unique pleiotropic effect. Cerebrolysin is a peptide mixture that penetrates the blood-brain barrier in significant amounts and mimics the effects of NGF.

METHODS

Comparative analysis: Cerebrolysin treated (10 ml x 2/day, i.v. x 3 weeks) vs. non-treated, in patients (all received aside, a rather equivalent complementary, pharmacological and physical, therapy). Two lots of patients, admitted in our Physical & Rehabilitation (neural-muscular) Medical-PR(n-m)M-Clinic Division, during 2007-2009: 69 treated with Cerebrolysin (22 F, 47 M; Average: 59.333; Mean of age: 61.0 Years old; Standard deviation 16.583) and 70 controls (41 F, 29 M; A: 70.014; M.o.a.: 70.5 Y.o.; S.d.: 6.270) were studied. The total number of assessed items was 13: most contributive in relation with the score of Functional Independence Measure at discharge (d FIM), were: admission (a FIM), number of physical therapy days (PT), number of hospitalization days (H), age (A) and--relatively--days until the first knee functional extension (KE). Concomitantly, the main/key, focused on neuro-motor rehabilitative outcomes, functional/analytical parameters, have been assessed regarding the speed in achieving their functional recovery.

RESULTS

Concerning d FIM, there have not been objectified significant differences between the two lots (p=0.2453) but regarding key, focused on neuro-motor rehabilitative outcomes, functional/analytical parameters: KE (p=0.0007) and days until the first time recovery of the ability to walk between parallel bars (WPB--p=0.0000)--highly significant differences in favor of Cerebrolysin lot resulted.

CONCLUSION

Cerebrolysin administration, as neurorehabilitative outcomes, proved to hasten, statistically significant, especially the recovery of some critical, for standing and walking, parameters. Thus encouraged, we have now initiated a comprehensive national, 5 year retrospective, multi-centre--based on unitary data acquisition frame and mathematical apparatus--study, to evaluate the results of the treatment with Cerebrolysin in traumatic brain injuries (TBI).