Neuroprotection of taurine through inhibition of 12/15 lipoxygenase pathway in cerebral ischemia of rats

Background: Cerebral ischemia exhibits a multiplicity of pathophysiological mechanisms. Taurine (Tau), an endogenous substance, possesses a number of cytoprotective properties. The aim of the present study was to examine the neuroprotective effect of Tau, through affecting 12/15 lipoxygenase (12/15-LOX) signal pathway in an acute permanent middle cerebral artery occlusion (MCAO) model of rats.

Methods: Sprague-Dawley rats were randomly divided into 3 groups (n = 10), namely the sham-operated group, MCAO group and Tau group. Tau was intraperitoneally administrated immediately after cerebral ischemia. At 24 h after MCAO, neurological function score, brain water content and infarct volume were assessed. The expression of 12/15-lipoxygenase (12/15-LOX), p38 mitogen-activated protein kinase (p38 MAPK), and cytosolic phospholipase A2 (cPLA2) was measured by Western blot. Enzyme-linked immunosorbent assay was used to evaluate the inflammatory factors TNF-α, IL-1β and IL-6 in serum.

Results: Compared with MCAO group, taurine significantly improved neurological function and significantly reduced brain water content (p < 0.05) and infarct volume (p < 0.05). Consistent with these indices, the overexpressions of 12/15-LOX, p38 MAPK, cPLA2, tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) were significantly decreased in Tau group (p < 0.05).

Conclusion: Taurine protected the brain from damage caused by MCAO; this effect may be through down-regulation of 12/15-LOX, p38 MAPK, and cPLA2.     

The CD40/CD40L system regulates rat cerebral microvasculature after focal ischemia/reperfusion via the mTOR/S6K signaling pathway

Objective: The role of CD40/CD40 ligand (CD40L) in microvascular thrombosis is now widely accepted. However, the exact mechanisms linking the CD40/CD40L system and the soluble form of CD40L (sCD40L) with microvascular thrombosis are currently a topic of intensive research. The objective of this study was to assess the potential mechanisms in CD40/CD40L system-regulated microvascular thrombosis after focal ischemia/reperfusion (I/R).

Methods: Rats were subjected to 60-min transient middle cerebral artery occlusion (MCAO). The experiments were divided into three groups: sham operation, MCAO, and MCAO + CD40 antagonist. Dynamic changes of serum-free sCD40L levels for 0, 1, 3, 5, 6, and 12 h by ELISA detecting kit after focal I/R were observed, and the CD40 expression levels in both platelet surface and vascular endothelial cell surface were measured by flow cytometry and immunofluorescence, respectively. Cerebral infarct volume was analyzed 12 h after reperfusion. mTOR/S6K signaling was determined by Western blot.

Results: A comparison of thrombus formation between MCAO and CD40 antagonist treatment rats revealed a role for CD40 and/or CD40L in the inflammation-enhanced thrombosis responses in both of the platelet and vascular endothelial cell. MCAO rats yielded an acceleration of thrombus formation that was accompanied by increased CD40 levels in serum. The brain infarction was significantly decreased in CD40 antagonist treatment group compared to MCAO model group. The mTOR/S6K signaling was activated in MACO model than that of CD40 antagonist treatment group.

Conclusions: Our findings indicate that CD40/CD40L system contributes to microvascular thrombosis and brain infarction induced by MCAO and reperfusion. The mTOR/S6K signaling pathway is involved in the regulation of cerebral microvasculature after focal I/R by CD40/CD40L.

Abbreviations:

AKT: protein kinase B; CD40L: CD40 ligand; CSF: cerebrospinal fluid; FITC: fluorescein isothiocyanate; I/R: ischemia/reperfusion; MCAO: middle cerebral artery occlusion; mTOR: mechanistic target of rapamycin; PE: P-phycoerythrin; sCD40L: soluble form of CD40L; TNF-a: tumor necrosis factor-alpha; WT: wild type.     

Promoting physical activity in hospitalized patients with mild ischemic stroke: a pilot study

Background: Patients with acute stroke spend most of their hospital day inactive. However, a method to promote physical activity (PA) in stroke has not been established.

Objective: To evaluate the effectiveness of promoting PA by enhancing self-efficacy in hospitalized patients with mild ischemic stroke.

Design: Pre–post interventional study.

Methods: Hospitalized patients with mild ischemic stroke who could walk without assistance were recruited. We measured the daily number of steps taken as the index of daily hospitalized PA using an accelerometer. At the baseline measurement, patients did not receive accelerometer-based feedback. To promote hospitalized PA, a physical therapist provided instruction on the self-monitoring approach and discussed PA targets, encouraged the patients to walk more, and instructed them on the importance of PA after stroke. We also measured self-efficacy for PA using an assessment tool at the baseline and during the intervention.

Results: Twenty-two patients (62.5 years old, 68.2% men) were included. PA during the intervention was higher than that at the baseline measurement (5709.4 ± 2236.1 vs. 2813.9 ± 1511.9 steps/day, p < 0.001). Self-efficacy for PA during the intervention was also higher than that at the baseline measurement (76.4 ± 18.8 vs. 58.9 ± 29.0 points, p < 0.001).

Conclusions: Promoting PA by enhancing self-efficacy may increase PA and self-efficacy for PA in hospitalized patients with mild ischemic stroke. The present results might provide new strategies of PA promotion in these hospitalized patients.     

Comparison of the Mini-Balance Evaluations Systems Test with the Berg Balance Scale in relationship to walking speed and motor recovery post stroke*

Background: The Mini-BESTest is a recently developed balance assessment tool that incorporates challenging dynamic balance tasks. Few studies have compared the psychometric properties of the Mini-BESTest to the commonly used Berg Balance Scale (BBS). However, the utility of these scales in relationship to post stroke walking speeds has not been explored.

Objectives: The purpose of this study was to compare the sensitivity and specificity of the Mini-BESTest and BBS to evaluate walking speeds in individuals with stroke.

Design: A retrospective exploratory design.

Methods: Forty-one individuals with chronic stroke were evaluated with the Mini-BESTest, BBS, and 10-meter self-selected walk test (10MWT). Based on their self-selected gait speeds (below or above 0.8 m/s), participants were classified as slow and fast walkers.

Results: Significant linear correlations were observed between the Mini-BESTest vs. BBS (r = 0.72, p ≤ 0.001), Mini-BESTest vs. 10MWT (r = 0.58, p ≤ 0.001), and BBS vs. 10MWT (r = 0.30, p = 0.05). Independent t-tests comparing the balance scores for the slow and fast walkers revealed significant group differences for the Mini-BESTest (p = 0.003), but not for the BBS (p = 0.09). The Mini-BESTest demonstrated higher sensitivity (93%) and specificity (64%) compared to the BBS (sensitivity 81%, specificity 56%) for discriminating participants into slow and fast walkers.

Conclusions: The Mini-BESTest has a greater discriminative ability than the BBS to categorize individuals with stroke into slow and fast walkers.     

Investigation of subdural electrode displacement in invasive epilepsy surgery workup using neuronavigation and intraoperative MRI

Objectives: One of the main obstacles of electrode implantation in epilepsy surgery is the electrode shift between implantation and the day of explantation. We evaluated this possible electrode displacement using intraoperative MRI (iopMRI) data and CT/MRI reconstruction.

Methods: Thirteen patients (nine female, four male, median age 26 ± 9.4 years) suffering from drug-resistant epilepsy were examined. After implantation, the position of subdural electrodes was evaluated by 3.0 T-MRI and thin-slice CCT for 3D reconstruction. Localization of electrodes was performed with the volume-rendering technique. Post-implantation and pre-explantation 1.5 T-iopMRI scans were coregistered with the 3D reconstructions to determine the extent of electrode dislocation.

Results: Intraoperative MRI at the time of explantation revealed a relevant electrode shift in one patient (8%) of 10 mm. Median electrode displacement was 1.7 ± 2.6 mm with a coregistration error of 1.9 ± 0.7 mm. The median accuracy of the neuronavigation system was 2.2 ± 0.9 mm. Six of twelve patients undergoing resective surgery were seizure free (Engel class 1A, median follow-up 37.5 ± 11.8 months).

Conclusion: Comparison of pre-explantation and post-implantation iopMRI scans with CT/MRI data using the volume-rendering technique resulted in an accurate placement of electrodes. In one patient with a considerable electrode dislocation, the surgical approach and extent was changed due to the detected electrode shift.

Abbreviations: ECoG: electrocorticography; EZ: epileptogenic zone; iEEG: invasive EEG; iopMRI: intraoperative MRI; MEG: magnetoencephalography; PET: positron emission tomography; SPECT: single photon emission computed tomography; 3D: three-dimensional.     

Effect of whole body vibration on spasticity in hemiplegic legs of patients with stroke

Background: Several reports have focused on the effects of whole body vibration (WBV) on spasticity with differing results. Most studies used modified Ashworth scale (MAS) for qualitative measurements, but the effect was small.

Objective: To investigate the effect of WBV on spasticity in hemiplegic legs of patients with stroke using F-wave parameters.

Methods: Sixteen patients with stroke (mean age, 54.7 ± 13.5 years: time after stroke, 28.0 ± 26.3 months) were enrolled in a comparative before-and-after intervention trial. WBV was applied at 30 Hz (4–8 mm amplitude) for 5 min on the hamstrings, gastrocnemius, and soleus muscles in a sitting position. Spasticity was assessed according to the F-wave parameters, MAS, and active and passive range of motion (A-ROM and P-ROM, respectively). These assessments were obtained before, immediately after, and 20 min after each intervention.

Results: The F-wave parameters, MAS score, and P-ROM improved significantly after the WBV and remained below the baseline level, even after 20 min; no such change was noted in the unaffected limb via the F-wave parameters. The WBV also improved volitional movement immediately after intervention, as indicated by the A-ROM.

Conclusions: These results confirmed a significant reduction of motor neuron excitability until 20 min after the WBV, as indicated by F-wave parameters.     

Social phobia,depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking

Background: Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies.

Aim: We aimed to examine these associations in a large-scale follow-up study among middle adolescents.

Method: We surveyed 3278 Finnish adolescents with a mean age of 15 years for these disorders. Two years later, 2070 were reached and again surveyed for psychopathology and treatment seeking. Longitudinal associations between the self-reported disorders and treatment-seeking patterns for self-acknowledged ED symptoms were examined in multivariate analyses, controlling for SP/depression comorbidity and relevant socioeconomic covariates.

Results: Self-reported anorexia nervosa (AN) at age 15 years predicted self-reported depression at age 17 years. Furthermore, self-reported SP at age 15 years predicted not seeking treatment for bulimia nervosa (BN) symptoms, while self-reported depression at age 15 years predicted not seeking treatment for AN symptoms during the follow-up period.

Conclusions: Adolescents with AN should be monitored for subsequent depression. Barriers caused by SP to help seeking for BN, and by depression for AN, should be acknowledged by healthcare professionals who encounter socially anxious and depressive adolescents, especially when they present with eating problems.     

The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke: a randomized controlled pilot trial

Background: The changes effected by the inspiratory muscle training (IMT) on the structure of inspiratory muscles such as on the diaphragm, in patients with stroke, is unclear.

Objective: To investigate the effect of IMT on inspiratory function, diaphragm thickness, walking endurance, and fatigue in patients with stroke.

Methods: A total of 30 patients with stroke were randomized to either the experimental group or the control group. The experimental group (n = 15) underwent inspiratory muscle training with resistance adjusted to 30% of maximal inspiratory pressure, 90 breaths a day, 5 times a week for 6 weeks. Both groups received regular physical therapy for the same amount of time. The primary outcome measure was the diaphragm thickness ratio. The secondary outcomes were inspiratory function; maximal inspiratory pressure and inspiratory muscle endurance; and gait endurance and fatigue.

Results: There were significant differences between the two groups in the thickness ratio on the affected diaphragm thickness (medium effect size), maximal inspiratory pressure (medium effect size), and inspiratory muscle endurance (large effect size; Bonferroni correction p < 0.005). The gait endurance (medium effect size) and fatigue (small effect size) showed no significant differences in the between group comparison.

Conclusion: Inspiratory muscle training was effective in improving respiratory function and inducing structural changes, especially in the affected diaphragm.     

Neurological impairments in hypoxic neonates and lactate levels

Introduction: Metabolic acidosis with increasing lactate concentration develops due to the lack of oxygen in the tissues.

Objectives: The effect of lactic acidosis on neurological development in the first year of life.

Materials and Methods: Our study included 50 newborns with perinatal hypoxia requiring oxygen therapy and 50 healthy newborns. pH, pCO2, pO2, base excess (BE) and lactates from arterialized capillary blood were determined in both groups of newborns, in the first and second hours after birth, and neurological development in the first year of life was estimated.

Results: pH, pCO2, pO2, BE and lactates differed significantly between the groups in the first and second hours after birth p < 0.01. Hypotonia was recorded in 20/50 cases and hypertonia was recorded in 10/50 cases in the first year of life.

Conclusion: Lactate concentration may be an indicator of neurological damage in neonates with perinatal hypoxia.     

Voxel-based morphometry of disgust sensitivity

Background: Difficulties with the regulation of negative affect have been extensively studied in neuroimaging research. However, dysregulation of a specific emotion, disgust, has hardly been investigated. In the present study, we used voxel-based morphometry to identify whether gray matter volume (GMV) of frontal regions is correlated with personality traits associated with general and disgust-specific emotion regulation difficulties.

Method: We analyzed T1-weighted images of 49 females (mean age = 22.8 years, SD = 3.2). The women rated their disgust sensitivity (DS) (temporally stable tendency to experience disgust as uncontrollable and extremely aversive) as well as general difficulties with emotion regulation.

Results: DS and general emotion regulation deficits were positively associated with a heightened GMV of the orbitofrontal cortex. DS additionally showed a negative association with GMV of the medial prefrontal cortex.

Conclusion: The present study revealed shared and distinct contributions of frontal brain regions to disgust-specific and general emotion regulation difficulties.     

The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis

Background: Virtual reality (VR) is becoming a popular alternative to traditional upper and lower limb rehabilitation following a stroke.

Objective: To conduct a systematic review and meta-analysis on the effectiveness of VR interventions for improving balance in a chronic stroke (≥6 months) population.

Data sources: A literature search of Pubmed, Scopus, CINAHL, Embase, Psycinfo, and Web of Science databases was conducted.

Study selection: English randomized controlled trials published up to September 2015 assessing balance with VR in chronic stroke participants.

Data extraction: Mean and standard deviations from outcome measures were extracted. Pooled standard mean differences ± standard error were calculated for the Berg Balance Scale (BBS) and the Timed Up and Go test (TUG).

Results: In total, 20 studies were selected which assessed the Nintendo^® Wii Fit balance board (n = 7), treadmill training and VR (n = 7), and postural training using VR (n = 6). Significant improvements were found for VR interventions evaluating the BBS (n = 12; MD = 2.94 ± 0.57; p < 0.001) and TUG (n = 13; MD = 2.49 ± 0.57; p < 0.001). Sub-analyses revealed postural VR interventions had a significant effect on BBS (n = 5) and TUG (n = 3) scores (BBS: MD = 3.82 ± 0.79; p < 0.001 and TUG: MD = 3.74 ± 0.97; p < 0.001). VR and treadmill training (n = 5) had a significant effect on TUG scores (MD = 2.15 ± 0.89, p = 0.016).

Conclusion: Overall, VR interventions compared to conventional rehabilitation had significant improvements. The meta-analyses also suggest that the Nintendo^® Wii Fit balance board may not be effective, although further confirmatory studies are necessary. Results should be interpreted with caution due to differences in therapy intensities and effect sizes within the included studies.     

Shear wave elastography of the brachial plexus roots at the interscalene groove

Objectives: Sonoelastography is an emerging technology that has been used to evaluate the musculoskeletal system including the brachial plexus of peripheral nerves, which has been only recently considered for study by shear wave elastography. The purpose of this study is to establish the normal sonoelastographic features of the C5–C7 nerve roots of the brachial plexus.

Methods: Forty healthy individuals (21 males and 19 females) were enrolled in the study. Shear wave elastography was used to evaluate the C5–C7 nerve roots of the brachial plexus at the interscalene interval. Normal sonoelastographic values were obtained.

Results: The mean shear elastic modulus of the C5 nerve root was 16.9 kPa (range 5.9–28.8 ± 4.9 standard deviation, SD), 15.7 kPa (range 5.4–26.3 ± 4.3 SD) for the C6 nerve root, and 16 kPa (range 8–29 ± 4.6 SD) for the C7 nerve root. There was a significant statistical difference between both sexes in the elastic modulus at the C6 and C7, but not at the C5 nerve roots. Significant inverse correlation with height was noted at the C6 nerve root. There was no statistical significant difference in tissue stiffness between right- and left-handed subjects, age, and body mass index.

Conclusion: The elastic modulus of the C5–C7 nerve roots has been determined in asymptomatic individuals and can serve as a reference when studying pathological conditions of these structures.

Abbreviations: BMI: body mass index; SWE: shear wave elastography.     

Effect of transcranial direct current stimulation on swallowing apraxia and cortical excitability in stroke patients

Background: Swallowing apraxia is characterized by impaired volitional swallowing but relatively preserved reflexive swallowing. Few studies are available on the effectiveness of behavioral therapy and management of the condition.

Objective: This study aimed to investigate the effect of transcranial direct current stimulation (tDCS) on swallowing apraxia and cortical activation in stroke patients.

Methods: The study included three inpatients (age 48–70 years; 1 male, 2 females; duration of stroke, 35–55 d) with post-stroke swallowing apraxia and six age-matched healthy subjects (age 45–65 years; 3 males, 3 females). Treatments were divided into two phases: Phase A and Phase B. During Phase A, the inpatients received three weeks of sham tDCS and conventional treatments. During Phase B, these patients received three weeks of anodal tDCS over the bilateral primary sensorimotor cortex (S₁M₁) of swallowing and conventional treatments. Swallowing apraxia assessments were measured in three inpatients before Phase A, before Phase B, and after Phase B. The electroencephalography (EEG) nonlinear index of approximate entropy (ApEn) was calculated for three patients and six healthy subjects.

Results: After tDCS, scores of swallowing apraxia assessments increased, and ApEn indices increased in both stimulated and non-stimulated areas.

Conclusions: Anodal tDCS might provide a useful means for recovering swallowing apraxia, and the recovery could be related to increased excitability of the swallowing cortex. Further investigations should explore the relationship between lesion size and/or lesion site and the prognosis of swallowing apraxia.

Clinical trial registry: http://www.chictr.org Registration Number: ChiCTR-TRC-14004955     

Sonographic assessment of optic nerve and ophthalmic vessels in patients with idiopathic intracranial hypertension

Background: Early diagnosis and proper monitoring of intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH) could reduce morbidity.

Objectives: The objective was to explore and monitor reflection of raised ICP in IIH on optic nerve sheath diameter (ONSD), papillary height and ophthalmic vessels hemodynamics, using transorbital sonography (TOS).

Methods: The study included 24 IIH patients and 30 controls. Patients were compared to controls (phase I) then reassessed twice; 1 week and 4 weeks later (phase II). Both groups underwent clinical evaluation and TOS to measure ONSD, papillary elevation, and color Doppler indices of the ophthalmic vessels. Patients underwent lumbar puncture (LP) to measure cerebrospinal fluid (CSF) pressure.

Results: ONSD was significantly higher in patients compared to controls (p < 0.001). The cut-off value was 6.2 mm. Papillary elevation (p = 0.006) and ONSD (p = 0.006) were significantly reduced 4 weeks following LP. Baseline color Doppler indices of the ophthalmic vessels were comparable between both groups and the changes observed during the follow-up visits in the patients were insignificant.

Conclusion: Reflected ICP changes on ONSD and papilla, measured by TOS, could be a valuable noninvasive additional tool to diagnose and monitor IIH patients. IIH insignificantly influences ophthalmic vessels hemodynamics.

Abbreviation BMI: Body mass index. CSF: Cerebrospinal fluid. EDV: End diastolic velocity. ICP: Intracranial pressure. IH:intracranial hypertension. IIH: Idiopathic intracranial hypertension. LP: Lumbar puncture. MI: Mechanical index. MRI: Magnetic resonance imaging. MRV: Magnetic resonance venography. OA: Ophthalmic artery OND: Optic nerve diameter. ONSD: Optic nerve sheath diameter. OV: Ophthalmic vein. PIs: Pulsatility indices. PSV: Peak systolic velocity. ROC: Receiver operator characteristic. TOS: Trans-orbital sonography.     

The curious case of processing unaccusative verbs in aphasia

Background: Individuals with agrammatic Broca’s aphasia (IWBA) exhibit a delay in lexical activation in S-V-O word order sentences and delayed lexical reactivation in sentences that contain syntactic dependencies. This pattern is in contrast to neurologically unimpaired individuals who immediately evince lexical reactivation at the gap in sentences that contain syntactic dependencies. However, in the case of sentences that contain unaccusative verbs, neurologically unimpaired individuals also exhibit a delay in lexical reactivation. This delay provides a unique opportunity to further examine lexical delays in IWBA.

Aim: The purpose of the current studies is to investigate the online comprehension of sentences that contain unaccusative verbs in IWBA and in a group of age-matched control (AMC) individuals.

Methods and Procedures: Cross-modal picture priming was used to test for priming of a displaced lexical item (direct object noun) immediately after the unaccusative verb (at the gap) during the ongoing auditory stream and at three additional time points downstream from the verb (500 ms, 750 ms, and 1,250 ms).

Outcomes and Results: Delayed reactivation of the displaced lexical item downstream from the gap (similar to prior reports of delayed reactivation with younger unimpaired listeners) for both the AMCs and the IWBA was found.

Conclusion: These results provide support that IWBA do not evince a delayed time course of lexical reactivation for unaccusative verbs compared to neurologically unimpaired individuals.     

Effects of repeated 9 and 30-day exposure to extremely low-frequency electromagnetic fields on social recognition behavior and estrogen receptors expression in olfactory bulb of Wistar female rats

Objective: We investigated the short- and long-term effects of extremely low-frequency electromagnetic fields (EMF) on social recognition behavior and expression of α- and β-estrogen receptors (ER).

Methods: Rats were exposed to 60-Hz electromagnetic fields for 9 or 30 days and tested for social recognition behavior. Immunohistochemistry and western blot assays were performed to evaluate α- and β-ER expression in the olfactory bulb of intact, ovariectomized (OVX), and ovariectomized+estradiol (E2) replacement (OVX+E2).

Results: Ovariectomization showed impairment of social recognition after 9 days of EMF exposure and a complete recovery after E2 replacement and so did those after 30 days. Short EMF exposure increased expression of β-ER in intact, but not in the others. Longer exposure produced a decrease in intact but an increase in OVX and OVX+E2.

Discussion: Our findings suggest a significant role for β-estrogen receptors and a lack of effect for α-estrogen receptors on a social recognition task.

Abbreviations: EMF: extremely low frequency electromagnetic fields; ERs: estrogen receptors; OB: olfactory bulb; OVX: ovariectomized; OVX + E₂: ovariectomized + estradiol replacement; IEI: interexposure interval; β-ER: beta estrogen receptor; E₂: replacement of estradiol; GAPDH: glyceraldehyde-3-phosphate dehydrogenase; WB: Western blot; PBS: phosphate-buffer saline; PB: phosphate-buffer     

Validation of the assessment of living with aphasia in Singapore

Background: The Assessment of Living with Aphasia (ALA) is a pictographic, self-report measure of aphasia-related quality of life (QoL). It has yet to be used in the Singapore population or adapted to other languages.

Aims: To examine the reliability and validity of the ALA and develop a Mandarin Chinese adaptation, the ALA-C, in the Singapore context.

Methods & procedures: Linguistic validation of the ALA was conducted to derive the ALA-C. People with aphasia (PWA) who were at least 6 months post-onset underwent the ALA/ALA-C and a series of reference measures in their dominant language (English/Mandarin). Test–retest reliability was evaluated using intra-class correlations and internal consistency using Cronbach’s alpha. Eight reference measures were administered to assess construct validity.

Outcomes & results: Sixty-six PWA were recruited to the study. Both the ALA and ALA-C showed excellent internal consistency (α = 0.97/0.96) and test–retest reliability (intraclass correlation = 0.97/0.98), and acceptable convergent (r = 0.63–0.83 and 0.70–0.83 respectively) and discriminant (r = 0.45–0.60 and 0.39–0.53, respectively) validity.

Conclusions: Both ALA and ALA-C demonstrated excellent reliability and good validity. Further research is warranted to examine use by more practicing clinicians and with more participants of varying degrees of aphasia severity to enable additional investigation of its psychometric properties.     

The effect of self-management education following mild stroke: an exploratory randomized controlled trial*

Background: Mild stroke comprises 53% of stroke hospital admissions; however, the majority of those with mild stroke patients receive little support to address chronic symptoms following stroke.

Objectives: To evaluate the feasibility and preliminary effect of the Chronic Disease Self-Management Program (CDSMP) for use with individuals immediately post mild-stroke.

Methods: Single-blind, exploratory, randomized controlled trial with participants who sustained a mild stroke (NIHSS <6). Participants were randomized to either receive the CDSMP intervention or to an inactive control group. Primary outcomes were self-reported health and self-efficacy and were obtained at baseline, post-intervention (treatment group only), and at six months post-baseline. Wilcoxon Signed Rank Tests were used to compare change score differences for all participants and effect size was computed using effect size r for non-parametric data.

Results: There were no differences between groups in demographics or baseline data with the exception of how participants felt they are able to manage their health in general (p = 0.05). At follow-up, effect sizes ranged from 0 to 0.35 (no effect to medium effect); however, while the treatment group reported improvements in several areas of health at follow-up, the results are not compelling when compared to the control group over the same time period.

Conclusions: The results did not identify a positive effect that would support the use of the CDSMP with individual’s post-mild stroke; however, the generalizability of these results is limited secondary to several limitations in this exploratory study.     

Remote ischemic postconditioning protects the brain from focal ischemia/reperfusion injury by inhibiting autophagy through the mTOR/p70S6K pathway

Objective: Remote ischemic postconditioning (RIPostC) has been recognized as an applicable strategy for protecting against cerebral ischemia/reperfusion (I/R) injury. This study was performed to examine the effect of RIPostC on cerebral I/R and to explore its underlying mechanism.

Methods: Healthy male SD rats (N = 36) were assigned randomly into 3 groups of 12 each: sham group, I/R model group and RIPostC group. Animal models were performed by filament insertion for 2 h with middle cerebral artery occlusion(MCAO) followed by 24 h of reperfusion. RIPostC was induced by 15 min occlusion of femoral arteries followed by 15 min of reperfusion for 3 cycles at the beginning of middle cerebral artery reperfusion. The neurological deficits, infarct size and brain edema were determined. Autophagy was examined by transmission electron microscopy (TEM). The protein levels of microtubule-associated protein light chain 3 (LC3-II), mammalian target of rapamycin (mTOR), serine/threonine kinase p70S6 kinase (p70S6K), and their phosphorylation (p-mTOR and p-p70S6K) in the brain tissue of the rats were determined by western blotting.

Results: Our results suggested that RIPostC significantly reduced I/R-induced brain injury, as exhibited by a significantly decreased infarct size, mitigated brain edema and improved neurological deficits. RIPostC also significantly reduced the LC3-II/LC3-I ratio and protein expression of Beclin 1. Much less severe neuronal injury and fewer autophagosomes were observed by TEM in the RIPostC group.

Conclusions: These results suggest that RIPostC attenuates cerebral I/R injury by inhibiting autophagy through the activation of the mTOR/p70S6K signaling pathway.     

The prevalence of insomnia and its socio-demographic and clinical correlates in older adults in rural China: a pilot study

Objectives: To investigate the prevalence of insomnia (DIS: difficulty initiating sleep; DMS: difficulty maintaining sleep; and EMA: early morning awakening), its socio-demographic and clinical correlates, and the treatment patterns in older adults in rural China.

Method: A sample of 263 subjects was recruited in Mianyang and interviewed using standardized instruments. Basic socio-demographic and clinical data were collected.

Results: The expected mean total sleep time (TST) of the whole sample was 6.8 ± 2.2 hours, and the actual mean TST was 6.3 ± 2.1 hours. The 1-year prevalence of at least one type of insomnia was 7.6%; the rates of DIS, DMS, and EMA were 5.7%, 7.2%, and 6.8%, respectively. On multivariate analyses, female sex and psychiatric disorders were independently associated with more frequent insomnia.

Conclusion: Insomnia is not uncommon in older adults in rural China, and the low percentage of subjects treated suggests that improved access to treatment might be indicated.