The relationship between motor recovery and gait velocity during dual tasks in patients with chronic stroke

[Purpose] The aims of this study were to identify the relationship between motor recovery and gait velocity during dual tasks in patients with chronic stroke and determine automatic gait ability following stroke. [Subjects and Methods] Thirty-three outpatients and twelve healthy subjects participated in a cross-sectional assessment. Community ambulation was assessed using a self-administered questionnaire. Outcome measures included the Motricity index, Berg Balance Scale, and gait speed under three conditions (self-paced ambulation for 10 m, ambulation while performing dual cognitive tasks, and ambulation while performing dual manual tasks). Gait automaticity was calculated. [Results] No significant differences were observed for muscle strength or balance between the limited community ambulation and the community ambulation groups. However, a significant difference in gait velocity was observed between the groups under the three conditions. In particular, a significant difference was detected only in the limited community ambulation group depending on the level of motor function recovery during cognitive and manual dual task ambulation. Additionally, we revealed that the community ambulation group had a lower level of gait automaticity compared with that in the normal group. [Conclusion] Our results show the influence of motor recovery on the change in gait velocity depending on the task if a patient is limitedly ambulatory. We revealed that community ambulators did not have a sufficient level of gait automaticity.     

The Ascending Reticular Activating System in a Patient With Severe Injury of the Cerebral Cortex: A Case Report

We reported on the ascending reticular activating system (ARAS) finding of a patient in whom severe injury of the cerebral cortex was detected following a hypoxic-ischemic brain injury (HIBI).A 67-year-old female patient who suffered from HIBI induced by cardiac arrest after surgery for lumbar disc herniation underwent cardiopulmonary resuscitation approximately 20 to 30 minutes after cardiac arrest. The patient exhibited impaired alertness, with a Glasgow Coma Scale (GCS) score of 4 (eye opening: 2, best verbal response: 1, and best motor response: 1). Approximately 3 years after onset, she began to whimper sometimes and showed improved consciousness, with a GCS score of 10 (eye opening: 4, best verbal response: 2, and best motor response: 4) and Coma Recovery Scale-Revised score of 9 (auditory function: 1, visual function: 1, motor function: 2, verbal function: 2, communication: 1, and arousal: 2).Results of diffusion tensor tractography for the upper connectivity of the ARAS showed decreased neural connectivity to each cerebral cortex in both hemispheres. The right lower ARAS between the pontine reticular formation and the thalamic intralaminar nuclei (ILN) was thinner compared with the left side.Severe injury of the upper portion of the ARAS between the thalamic ILN and cerebral cortex was demonstrated in a patient with some level of consciousness.     

Real-world cost-effectiveness of drug-eluting stents vs. bare-metal stents for coronary heart disease—A five-year follow-up study

Objective

To evaluate the cost-effectiveness of using drugeluting stents (DES) compared to bare-metal stents (BMS) for coronary heart disease (CHD).

Interval breast cancer risk associations with breast density,family history and breast tissue aging

Interval breast cancers (those diagnosed between recommended mammography screens) generally have poorer outcomes and are more common among women with dense breasts. We aimed to develop a risk model for interval breast cancer. We conducted a nested case–control study within the Melbourne Collaborative Cohort Study involving 168 interval breast cancer patients and 498 matched control subjects. We measured breast density using the CUMULUS software. We recorded first-degree family history by questionnaire, measured body mass index (BMI) and calculated age-adjusted breast tissue aging, a novel measure of exposure to estrogen and progesterone based on the Pike model. We fitted conditional logistic regression to estimate odds ratio (OR) or odds ratio per adjusted standard deviation (OPERA) and calculated the area under the receiver operating characteristic curve (AUC). The stronger risk associations were for unadjusted percent breast density (OPERA = 1.99; AUC = 0.66), more so after adjusting for age and BMI (OPERA = 2.26; AUC = 0.70), and for family history (OR = 2.70; AUC = 0.56). When the latter two factors and their multiplicative interactions with age-adjusted breast tissue aging (p = 0.01 and 0.02, respectively) were fitted, the AUC was 0.73 (95% CI 0.69–0.77), equivalent to a ninefold interquartile risk ratio. In summary, compared with using dense breasts alone, risk discrimination for interval breast cancers could be doubled by instead using breast density, BMI, family history and hormonal exposure. This would also give women with dense breasts, and their physicians, more information about the major consequence of having dense breasts—an increased risk of developing an interval breast cancer.