On Women Who Hate Their Husbands†

Objective: We assessed the feasibility and satisfaction of an apartment living program for formerly homeless adults with mental health and substance use disorders. Method: A one-group pretest-posttest design was used with 22 participants who attended a six-week apartment living program. Results: Sixteen participants completed the study and demonstrated improvement in the performance of and satisfaction with needed daily life skills (performance: Z = ?3.56, p ≤ 0.000, d = ?1.86; satisfaction: Z = ?2.84, p ≤ 0.004, d = ?1.85), interpersonal skills (Z = ?3.52, p ≤ 0.000, d = ?2.98) and quality-of-life scores (Z = ?3.52, p ≤ 0.000, d = ?1.34). Participants reported high levels of satisfaction with the program. Conclusion: This study demonstrates the feasibility and satisfaction of an apartment living program and warrants further research.     

Association of BDNF G196A Gene Polymorphism with Ischemic Stroke Occurrence and its 6-Month Outcome in an Iranian Population

Background: Genetic factors like the allele for Brain-Derived Neurotrophic Factor (BDNF) are associated with the outcome of ischemic stroke most likely through affecting neural differentiation and synaptic plasticity. Studies of the association of BDNF G196A gene polymorphism and long-term ischemic stroke outcome in various populations have not been concordant.

Objective: In this research, the association of BDNF G196A gene polymorphism and ischemic stroke occurrence were studied in a northern Iranian population with a glance to its 6-month outcome.

Methods: The genetic variant of BDNF G196A was examined in Ischemic Stroke (IS) patients (n = 206) and control group (n = 200). In IS individuals, outcome variables such as stroke severity, functional disability, and cognitive impairment were examined, respectively, by NIHSS, Barthel Index, and MoCA in an average of 202 days after the stroke occurrence.

Results: The frequency of risk allele G was 12.1% in IS patients and 5.5% in healthy individuals; and the difference was statistically significant (p < 0.0001). The frequency of risk genotype GG, heterozygote and homozygote were 0% and 1%, 24%.3% and 9%, 75.7% and 90%, respectively, for IS and control groups (p < 0.05). After controlling the phenotype confounding factors, logistic regression analysis showed that there was a borderline significant relationship between genotype BDNF GA + GG and IS occurrence (AOR = 1.997,95% CI: 0.252–1.010, p = 0.051). There was no significant difference between the various genotypic groups regarding the severity of the stroke and functional disability. Yet, G allele carriers had more cognitive impairment after IS (p = 0.002).

Conclusion: For the first time in an Iranian population, it was demonstrated that BDNF G196A variant plays a major role in stroke occurrence and consequences. It is suggested that, after IS, G allele carriers should have precedence for medicinal and rehabilitation interventions, in order to reduce their cognitive deficiency.     

HIV-associated executive dysfunction in the era of modern antiretroviral therapy: A systematic review and meta-analysis

Objective: While some reports suggest that HIV+ individuals continue to display executive function (EF) impairment in the era of cART, findings have been contradictory and appear to differ based on the aspect of EF being measured. To improve the understanding of how discrete executive abilities may be differentially affected or spared in the context of HIV infection, we conducted a systematic review and meta-analysis to (a) determine whether and to what extent HIV+ adults experience deficits in EFs, and (b) understand how demographic and clinical characteristics may modify the associations between HIV infection and executive abilities.

Method: Studies comparing HIV+ and HIV-uninfected groups on measures of working memory, set-shifting, inhibition, decision-making, and apathy between 2000 and 2017 were identified from three databases. Effect sizes (Cohen’s d) were calculated using inverse variance weighted random effects models. Meta-regression was used to examine the moderating effect of demographic and clinical variables.

Results: Thirty-seven studies (n = 3935 HIV+; n = 2483 HIV-uninfected) were included in the meta-analysis. Pooled effect sizes for deficits associated with HIV infection were small for domains of set-shifting (d = ?0.34, 95% CI [?0.47, ?0.20]) and inhibition (d = ?0.31, 95% CI [?0.40, ?0.21]), somewhat larger for measures of decision-making (d = ?0.41, 95% CI [?0.53, ?0.28]) and working memory (d = ?0.42, 95% CI [?0.59, ?0.29]), and largest for apathy (d = ?0.87, 95% CI [?1.09, ?0.66]). Meta-regression demonstrated that age, sex, education, current CD4 count, and substance dependence differentially moderated the effects of HIV infection on specific EFs. However, lower nadir CD4 count was the only variable associated with greater deficits in nearly all EF domains.

Conclusions: Our results suggest that discrete domains of EF may be differentially affected by HIV infection and moderating demographic and clinical variables. These findings have implications for the development of targeted cognitive remediation strategies.     

Circulating insulin-like growth factor 1 and insulin-like growth factor binding protein-3 level in Alzheimer’s disease: a meta-analysis

It has been reported that the associations between circulating insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) and Alzheimer’s disease (AD) are controversial. Thus, present meta-analysis was carried out to confirm the probable associations. We searched “PubMed”, “Springer” and “Medline” databases using the term (“insulin-like growth factor-1” or “IGF-1” or “insulin-like growth factor binding protein-3” or “IGFBP-3”) and (“Alzheimer’s disease”) until April 2016. Furthermore, standard mean differences (SMDs) were calculated. A total of seven reports involving 1342 percipients were pooled. SMDs were ?0.25 (P = 0.22) and ?0.33 (P = 0.08) for IGF-1 and IGFBP-3, respectively. Furthermore, the circulating IGF-1 levels in AD patients were lower than controls when studies with the difference of mean age ≤1 year (SMD ?0.57, P = 0.007) or 2 years (SMD ?0.58, P = 0.02) or difference of mean MMSE scores ≤10 scores (SMD ?0.94, P < 0.00001), or studies from Europe (SMD ?0.89, P < 0.00001) were excluded. In addition, the circulating IGFBP-3 levels in AD patients were lower than controls when studies with the difference of mean age ≤2 years (SMD ?0.62, P = 0.006) or difference of mean MMSE scores ≤6 scores (SMD ?0.48, P = 0.0004), 7 scores (SMD ?0.58, P = 0.02), or 8 scores (SMD ?0.80, P = 0.03) were excluded. Even though no significant difference of circulating IGF-1 and IGFBP-3 levels in AD patients comparing with controls was found in present meta-analysis, the current study provided the evidence that the circulating IGF-1 and IGFBP-3 level in AD patients were influenced by the difference of mean age as well as MMSE scores. Furthermore, circulating IGFBP-3 levels in AD patients may be decreased earlier than IGF-1.     

Effect evaluation on use of bedside fiber bronchoscope in treating stroke-associated pneumonia

Background The bedside fiber bronchoscope has been widely used in the diagnosis and treatment of respiratory disease. This study aims to assess the effect of using bedside fiber bronchoscope in sputum suction and alveolar lavage for treatment of stroke-associated pneumonia (SAP), compared with the use of conventional suction catheter.

Methods One hundred and six patients with SAP were randomly divided into control group (n = 53) and experimental group (n = 53) for a controlled study. Patients in the two groups were conventionally treated with phlegm-resolving and anti-infective therapy. The conventional suction catheter was used for sputum suction for patients in the control group, while bedside fiber bronchoscope was used for sputum suction and alveolar lavage in the experimental group. Clinical pulmonary infection score (CPIS) of the two groups was carried out. The heart rate, blood gas, levels of inflammatory factors in serum, and CPIS were contrastively analyzed between the two groups.

Results The blood gas (including pH, PaCO₂, PaO₂) levels of inflammatory factors in serum such as C-reactive protein, procalcitonin, interleukin-6 and tumor necrosis factor, and CPIS (including the third day and seventh day) in the experimental group (n = 53) were all superior to those of the control group (n = 53) (p < 0.05). The results suggested that the pulmonary ventilation condition and inflammatory response of patients with SAP were significantly improved with the use of bedside fiber bronchoscope.

Conclusion The use of bedside fiber bronchoscope is beneficial in modifying the pulmonary ventilation and relieving systemic inflammatory response of patients with SAP, exhibiting a great value in clinical application.     

Association between Endothelial nitric oxide synthase G894T gene polymorphism and risk of ischemic stroke in North Indian population: a case-control study

Background and purpose: Stroke is a multi-factorial disease influenced by both genetic and environmental factors. The aim of this case-control study was to determine the association between Endothelial Nitric Oxide Synthase G894T (rs1799983) gene polymorphism and susceptibility to ischemic stroke (IS) in North Indian population.

Methods: In this present case-control study, genotyping was performed by using Polymerase chain reaction – Restriction fragment length polymorphism (PCR-RFLP) method for 250 IS patients and 250 age and sex matched controls. PCR results were confirmed by DNA sequencing. Frequency distribution of genotypes and alleles were compared between cases and controls using conditional logistic regression.

Results: Hypertension, Diabetes, Dyslipidemia, Low Socioeconomic Status and Family History of Stroke were found to be independent risk factors for IS. Mean age of cases and controls were 52.83 ± 12.59 and 50.97 ± 12.70 years. Multivariate logistic regression analysis showed a significant association between eNOS G894T (rs1799983) polymorphism and risk of IS [OR = 1.57; 95%CI 1.05–2.37; p = 0.028] under dominant model. Based on Trial of Org 10172 in Acute Stroke Treatment classification, an independent association of large vessel disease (LVD) was observed with the risk of IS under the dominant [OR = 2.09; 95% CI 1.17–3.75; p = 0.01] and recessive [4.09 95% CI 1.06–15.68; p = 0.04] models. All the observed genotype frequencies were in accordance with the Hardy–Weinberg equilibrium (HWE) in both cases and controls.

Conclusion: The findings of the present study suggest that polymorphism in G894T position of eNOS gene might be a risk factor for IS mainly for LVD stroke subtype in North Indian population. Further large prospective studies are required to confirm these findings.     

Excessive release of endogenous neuropeptide Y into cerebrospinal fluid after treatment of spontaneous subarachnoid haemorrhage and its possible impact on self-reported neuropsychological performance – results of a prospective clinical pilot study on good-grade patients

ABSTRACT

Objectives: Neuropsychological dysfunction after treatment of spontaneous subarachnoid haemorrhage (sSAH) is common but underreported. The vasoconstrictor neuropeptide Y (NPY) is excessively released after sSAH and in psychiatric disorders. We prospectively analysed the treatment-specific differences in the secretion of endogenous cerebrospinal fluid (CSF) NPY during the acute stage after sSAH and its impact on cognitive processing.

Methods: A total of 26 consecutive patients (f:m = 13:8; mean age 50.6 years) with good-grade sSAH were enrolled (drop out n = 5): n = 9 underwent endovascular aneurysm occlusion, n = 6 microsurgery, and n = 6 patients with perimesencephalic SAH received standardized intensive medical care. Ventricular CSF was drawn daily from day 1–10. CSF NPY levels were determined with competitive enzyme immunoassay. All patients underwent neuropsychological self-report assessment [36-Item Short Form Health Survey (SF-36) and ICD-10-Symptom-Rating questionnaire (ISR)] after the onset of sSAH (day 11–35; t₁) and at the 6-month follow-up (t₂).

Results: At t₁, increased mean levels of NPY in CSF significantly correlated with impaired performance in most ISR scores (ISR total p = .018, depression p = .035, anxiety p = .008, nutrition disorder p = .047, supplementary items p = .038) and in several psychological SF-36 items (vitality p = .019, general mental health p = .001, mental component summary p = .025).

Discussion: To the best of our knowledge, this study is the first to correlate the levels of endogenous NPY in supratentorial CSF with cognitive outcome in good-grade sSAH patients. Excessive NPY release into CSF may have a short-term influence on the pathogenesis of neuropsychological deficits. The impact of cerebrovascular manipulation on NPY release has to be further elucidated.

Abbreviations: ANOVA: analysis of variance; aSAH: aneurysmal subarachnoid haemorrhage; AUC: area under the curve; CBF: cerebral blood flow; CSF: cerebrospinal fluid; CT (scan): computed tomography (scan); CV: cerebral vasospasm; DIND: delayed ischemic neurological deficit; DSA: digital subtraction angiography; EIA: enzyme immunoassay; EV: endovascular aneurysm occlusion; EVD: external ventricular drainage; FU: 6-month follow-up; GCS: Glasgow Coma Scale; Ghp: general health perceptions; GOS: Glasgow Outcome Scale; h: hour/s; HH: Hunt and Hess; ICU: intensive care unit; ISR: ICD-10-Symptom-Rating questionnaire; MCS: mental component summary; Mhi: general mental health; min: minute/s; min-max: minimum – maximum; ml: millilitre; mRS: modified Ranking Scale; MS: microsurgical clipping, microsurgical aneurysm occlusion; ng: nanograms; no. [n]: number; NPY: Neuropeptide Y; p: p value; Pain: bodily pain; PCS: physical component summary; Pfi: physical functioning; pSAH: perimesencephalic subarachnoid haemorrhage; PTSD: posttraumatic stress disorder; QoL: quality of life; Rawhtran: health transition item; Rolem: role limitations because of emotional problems; Rolph: role limitations due to physical health problems; SAH: subarachnoid haemorrhage; SD: standard deviation; SF-36: 36-Item Short Form Health Survey; Social: social functioning; sSAH: spontaneous subarachnoid haemorrhage; TCD: trans-cranial Doppler ultrasound; (test) t₁: test in the sub-acute phase after the onset of bleeding (between day 11 and 35 after subarachnoid haemorrhage); (test) t₂: test in the short-term (chronic phase) after treatment at 6-month follow-up; test t₁ - t₂: intergroup development from t₁ to t₂; Vital: vitality; vs: versus.     

Urinary trypsin inhibitor suppresses excessive superoxide anion radical generation in blood,oxidative stress,early inflammation,and endothelial injury in forebrain ischemia/reperfusion rats

Abstract

Objectives: To investigate the effects of ulinastatin, a urinary trypsin inhibitor (UTI), on jugular venous superoxide radical (O^?₂·) generation, oxidative stress, early inflammation, and endothelial activation in forebrain ischemia/reperfusion (FBI/R) rats.Methods: Fourteen Wistar rats were allocated to a control group (n = 7) and a UTI group (n = 7). Throughout the experiments, O^?₂· in the jugular vein was measured by the produced current using a novel electrochemical O^?₂· sensor. Forebrain ischemia was induced by occlusion of the bilateral common caroti darteries with hemorrhagic hypotension for 20 min, followed by reperfusion. In the UTI group, UTI (5 U/g) was administered intravenously immediately after reperfusion. At 60 min after reperfusion, plasma and brain were harvested, and malondialdehyde, high-mobility group box 1 (HMGB1) protein, and intercellular adhesion molecule-1 (ICAM-1) were measured.

Results: O^?₂· current increased gradually during forebrain ischemia in both groups. The current increased markedly in the control group immediately after reperfusion but was significantly attenuated in the UTI group after reperfusion. Brain and plasma malondialdehyde, HMGB1, and ICAM-1 were significantly attenuated in the UTI group compared with those in the control group, except for brain HMGB1, which was associated with the amount of O^?₂· generated during FBI/R.

Discussion: UTI suppressed jugular venous O^?₂· generation, oxidative stress, early inflammation, and endothelial activation in FBI/R rats. Therefore, UTI might be a useful agent for the therapy of the cerebral ischemia/reperfusion pathophysiology.     

Argatroban plus aspirin versus aspirin in acute ischemic stroke

Objectives: Anticoagulant therapy in the acute phase of AIS remains controversial. The aim of this study was to investigate whether argatroban benefited early stroke outcomes compared with antiplatelet treatment.

Methods: We reviewed data from 1,485 patients with AIS hospitalized at Tianjin Union Medical Center (TUMC) between 1 January 2013 and 31 December 2015 from the TUMC registry database. Patients were divided into two groups: an antiplatelet group (aspirin 300 mg daily) and an argatroban group (argatroban 60 mg for 2 days followed by 20 mg daily; or 20 mg daily – both regimens combination with aspirin 100 mg daily). Two primary outcomes, change in NIHSS score (baseline–discharge) and intracerebral hemorrhage, were investigated.

Results: No major symptomatic intracerebral hemorrhages were observed in either group. Both groups had significantly decreased NIHSS scores at discharge (Z = ?14.617, P < 0.001 and Z = ?6.385, P < 0.001, respectively), and there were no significant group differences in NIHSS score change (Z = ?1.888, P = 0.059). In the mild stroke subgroup, the argatroban group had a worse NIHSS score at discharge (Z = ?6.148, P = 0.002), while the aspirin group had an improved NIHSS score (Z = ?4,423, P < 0.001). In the moderate stroke subgroup, both groups had significantly decreased NIHSS scores at discharge (Z = ?13.260, P < 0.001 and Z = ?7.108, P < 0.001, respectively) and there were no significant group differences in NIHSS score changes (Z = ?1.888, P = 0.059).

Conclusion: Argatroban is effective and safe for the treatment of moderate AIS with similar efficacy to high-dose aspirin in the acute phase of AIS, although no additional benefit on short-term outcome was observed. For patients with mild AIS, argatroban may be inferior to high-dose aspirin.     

Increasing physical activity in stroke survivors using STARFISH,an interactive mobile phone application: a pilot study

Background: Following stroke, people are generally less active and more sedentary which can worsen outcomes. Mobile phone applications (apps) can support change in health behaviors. We developed STARFISH, a mobile phone app-based intervention, which incorporates evidence-based behavior change techniques (feedback, self-monitoring and social support), in which users’ physical activity is visualized by fish swimming.

Objective: To evaluate the potential effectiveness of STARFISH in stroke survivors.

Method: Twenty-three people with stroke (12 women; age: 56.0 ± 10.0 years, time since stroke: 4.2 ± 4.0 years) from support groups in Glasgow completed the study. Participants were sequentially allocated in a 2:1 ratio to intervention (n = 15) or control (n = 8) groups. The intervention group followed the STARFISH program for six weeks; the control group received usual care. Outcome measures included physical activity, sedentary time, heart rate, blood pressure, body mass index, Fatigue Severity Scale, Instrumental Activity of Daily Living Scale, Ten-Meter Walk Test, Stroke Specific Quality of Life Scale, and Psychological General Well-Being Index.

Results: The average daily step count increased by 39.3% (4158 to 5791 steps/day) in the intervention group and reduced by 20.2% (3694 to 2947 steps/day) in the control group (p = 0.005 for group–time interaction). Similar patterns of data and group–time interaction were seen for walking time (p = 0.002) and fatigue (p = 0.003). There were no significant group–time interactions for other outcome measures.

Conclusion: Use of STARFISH has the potential to improve physical activity and health outcomes in people after stroke and longer term intervention trials are warranted.     

The Beneficial Effects of Massage on Motor Development and Sensory Processing in Young Children with Developmental Delay: A Randomized Control Trial Study

ABSTRACT

Purpose: We investigated the effects of massage on young children with developmental delay but no clear diagnosis (e.g., cerebral palsy, genetic diseases, or autism).

Methods: Thirty-six children with DD, at 1–3 years of age, were randomly assigned to the massage (n = 18) or control group (n = 18) after being stratified by age and motor developmental quotient. The two groups continued to receive routine rehabilitation intervention, whereas the massage group additionally received 20 min of massage twice a week for 12 weeks. The Comprehensive Development Inventory for Infants and Toddlers – Diagnostic Test, the Infant/Toddler Sensory Profile – Chinese version, anthropometric measures, and a sleep questionnaire were administrated before and after the massage intervention.

Results: The results of analysis of covariance revealed that the massage group exhibited a greater improvement in the total motor score (p = 0.023), gross motor score (p = 0.047), and sensory sensitivity behavior (p = 0.042).

Conclusion: These findings suggest that massage can effectively enhance motor and sensory processing in children with DD.     

Performance validity in older adults: Observed versus predicted false positive rates in relation to number of tests administered

Introduction: This study examined false positive rates on embedded performance validity tests (PVTs) in older adults grouped by cognitive status.

Method: The research design involved secondary analysis of data from the National Alzheimer’s Coordinating Center database. Participants (N = 22,688) were grouped by cognitive status: normal (n = 10,319), impaired (n = 1,194), amnestic or nonamnestic mild cognitive impairment (MCI; n = 5,414), and dementia (n = 5,761). Neuropsychological data were used to derive 5 PVTs.

Results: False positive rates on individual PVTs ranged from 3.3 to 26.3% with several embedded PVTs showing acceptable specificity across groups. The proportion of participants failing two or more PVTs varied by cognitive status: normal (1.9%), impaired (6.6%), MCI (13.2%), and dementia (52.8%). Comparison of observed and predicted false positive rates at different specificity levels (.85 or .90) demonstrated significant differences in all comparisons. In normal and impaired groups, predicted rates were higher than observed rates. In the MCI group, predicted and observed comparisons varied: Predicted rates were higher with specificity at .85 and lower with specificity at .90. In the dementia group, predicted rates underestimated observed rates.

Conclusions: Despite elevated false positives in conditions involving severe cognitive compromise, several measures retain acceptable specificity regardless of cognitive status. Predicted false positive rates based on the number of PVTs administered were not observed empirically. These findings do not support the utility of simulated data in predicting false positive rates in older adults.     

Family appraisal of paediatric acquired brain injury: a social work clinical intervention trial

ABSTRACT

Objective: To compare the efficacy of a new intervention ‘Family Forward’ with ‘Usual Care’ social work practice in optimising family appraisal of a child’s acquired brain injury to ensure better adaptation during the inpatient rehabilitation phase of care and early transition home.

Research Design: Single site, prospective, sequential comparison group design.

Methods and Procedures: Families were recruited on admission to an inpatient rehabilitation service based at a tertiary paediatric hospital. The ‘Usual Care’ group (n = 22; 29 parents) recruitment, intervention and data collection were completed first (Phase 1), followed by the ‘Family Forward’ group (n = 25; 43 parents) (Phase 2). Parents/caregivers completed measures: (Impact of Event Scale- Revised: IES-R; Parents Experience of Childhood Illness and Brief Illness Perception Questionnaire: Brief IPQ) at the time of their child’s inpatient rehabilitation admission, inpatient rehabilitation discharge, and 6 weeks post-discharge.

Main Outcomes and Results: There were more children with traumatic brain injuries in the Family Forward group (n = 13) than Usual Care (n = 6) and the Family Forward group had a longer hospital admission (days, M = 56.4, SD = 46.1 vs. M = 37.5, SD = 16.4, p = 0.019). No significant group differences were found for family appraisal outcomes at any of the three time-points. Both groups reported reductions in trauma and grief responses, emotional experiences and perceptions of their child’s injury at post-intervention and follow-up. Both groups continued to have depleted emotional resources (PECI scale) at 6 weeks post-discharge.

Conclusions: The study contributes important insights into family appraisal experience in the early stages following paediatric acquired brain injury. In this context, ‘Family Forward’ needs to incorporate interventions that support and promote ongoing family appraisal as issues related to their child’s injury arise over time. Future research is needed to focus on whether the Family Forward approach does sustain family system adaptation (a key aim informing the design of the intervention) over the longer term.     

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.     

Duruöz Hand Index: Is it valid and reliable in children with unilateral cerebral palsy?

ABSTRACT

Purpose: To investigate the validity and reliability of the Duruöz Hand Index (DHI) in patients with unilateral cerebral palsy (CP). Methods: Assessments of patients (n = 23) were performed using the Modified Ashworth Scale (MAS), the Manual Ability Classification System (MACS), the grip and pinch strength tests, and DHI. Following the data collection, retest of DHI was administered telephonically within a 2-week period. Results: Test–retest reliability and internal consistency of DHI were found to be excellent with a Cronbach’s alpha value of 0.93 and an intraclass correlation coefficient value of 0.94. The correlation between the DHI and MACS was detected significantly high (r = 0.840, p = < 0.010). The DHI also correlated with grip and pinch strength in the affected side (r = ?0.459, p = < 0.050; r = ?0.509, p = < 0.050). Conclusions: DHI is a valid and reliable questionnaire for patients with unilateral CP.     

Quercetin attenuates neuronal autophagy and apoptosis in rat traumatic brain injury model via activation of PI3K/Akt signaling pathway

Objective: Neuronal autophagy and apoptosis play an irreplaceable role in brain injury pathogenesis and may represent a hopeful target for treatment. Previous studies have demonstrated that administration of quercetin-attenuated brain damage in a variety of brain injury models including traumatic brain injury (TBI). However, whether PI3K/Akt signaling pathway mediates the neuroprotection of quercetin following TBI is not well clarified. We sought to propose a hypothesis that quercetin could attenuate neuronal autophagy and apoptosis via enhancing PI3K/Akt signaling.

Methods: All rats were randomly arranged into four groups as follows: sham group (n = 25), TBI group (n = 25), TBI + quercetin group (n = 25), TBI + quercetin + LY294002 group (n = 25). Quercetin (Sigma, USA, dissolved in 0.9% saline solution) was administered intraperitoneally at a dose of 50 mg/kg at 30 min, 12 h, and 24 h after TBI. The neurological impairment and spatial cognitive function was assessed by the neurologic severity score and Morris water maze, respectively. Immunohistochemistry staining and western blotting was used to evaluate the expression of LC3, p-Akt, caspase-3, Bcl-2, and Bax.

Results: Quercetin treatment significantly attenuated TBI-induced neurological impairment (1–3 days, p < 0.05) and improved cognitive function (5–8 days, p < 0.05). Double immunolabeling demonstrated that quercetin significantly reduced the LC3-positive cells co-labeled with NeuN, whereas significantly enhanced p-Akt-positive cells co-labeled with NeuN. Furthermore, quercetin treatment reduced the expression of LC3、caspase-3 and Bax levels induced following TBI (p < 0.05), and increased the expression of p-Akt and Bcl-2 at 48 h (p < 0.05).

Conclusion: In conclusion, our observations indicate that post-injury treatment with quercetin could inhibit neuronal autophagy and apoptosis in the hippocampus in a rat model of TBI. The neuroprotective effects of quercetin may be related to modulation of PI3K/Akt signaling pathway.     

Subjective cognitive complaints and neuropsychological performance in former smokers with and without chronic obstructive pulmonary disease

Objective: This study examined the association of perceived cognitive difficulties with objective cognitive performance in former smokers. We hypothesized that greater perceived cognitive difficulties would be associated with poorer performance on objective executive and memory tasks.

Method: Participants were 95 former smokers recruited from the COPDGene study. They completed questionnaires (including the Cognitive Difficulties Scale [CDS] and the Hospital Anxiety and Depression Scale [HADS]), neuropsychological assessment, and pulmonary function testing. Pearson correlations and t-tests were conducted to examine the bivariate association of the CDS (total score and subscales for attention/concentration, praxis, delayed recall, orientation for persons, temporal orientation, and prospective memory) with each domain of objective cognitive functioning (memory recall, executive functioning/processing speed, visuospatial processing, and language). Simultaneous multiple linear regression was used to further examine all statistically significant bivariate associations. The following covariates were included in all regression models: age, sex, pack-years, premorbid functioning (WRAT-IV Reading), HADS total score, and chronic obstructive pulmonary disease (COPD) status (yes/no based on GOLD criteria).

Results: In regression models, greater perceived cognitive difficulties overall (using CDS total score) were associated with poorer performance on executive functioning/processing speed tasks (b = ?0.07, SE = 0.03, p = .037). Greater perceived cognitive difficulties on the CDS praxis subscale were associated with poorer performance on executive functioning/processing speed tasks (b = ?3.65, SE = 1.25, p = .005), memory recall tasks (b = ?4.60, SE = 1.75, p = .010), and language tasks (b = ?3.89, SE = 1.39, p = .006).

Conclusions: Clinicians should be aware that cognitive complaints may be indicative of problems with the executive functioning/processing speed and memory of former smokers with and without COPD.     

Prognostic value of serum thioredoxin levels in ischemic stroke

Objectives: Thioredoxin (Trx) is one of significant antioxidative molecules to diminish oxidative stress. Current evidence suggests that Trx is a potent antioxidant with cytoprotective functions. The aim of our study was to investigate specifically the association between serum Trx levels and acute ischemic stroke (AIS) patients.

Methods: 198 AIS patients and 75 controls were enrolled to the study. Serum Trx levels were measured using an enzyme-linked immunosorbent assay (ELISA). Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS) score on admission. Clinical endpoint was functional outcome measured by Barthel Index (BI) 3 months after admission. Multivariate binary logistic regression analyses were performed to identify predictors.

Results: We found that serum Trx levels were significantly increased in patients as compared to controls. Serum Trx was an independent biomarker to predict ischemic stroke (OR, 1.264; 95% CI, 1.04–1.537; P = 0.019). In addition, there was a negative correlation between NIHSS score at admission and serum Trx levels in cardioembolic stroke patients (r = ?0.422; P = 0.013). Furthermore, higher serum Trx levels in AIS patients were associated with favorable functional outcome. Serum Trx was an independent predictor for the functional outcome (OR, 0.862; 95% CI, 0.75–0.991; P = 0.037).

Conclusions: Serum Trx might be as a biomarker of cardioembolic stroke severity. Increased serum Trx levels could be a useful tool to predict good prognosis in patients with AIS.     

Survey-based assessment of the relationship between cognitive impairment and mentally stimulating activity in multiple sclerosis

Objectives: Cognitive impairment (CI) is a common and potentially debilitating component of the disease course in multiple sclerosis (MS). However, therapeutic options remain limited. It is unknown whether cognitively enriching activities reduce the burden of CI in patients with MS, as is found in other neurologic diseases affecting cognition. The aim of this study was to determine whether participation in cognitively enriching activities decreased self-reported CI in MS patients.

Methods: CI and activity levels were reported through electronic surveys completed by MS patients at the Cleveland Clinic. Responses were analyzed by univariable and multivariable regressions to identify factors associated with lower CI.

Results: We received 316 survey responses. Use of an assistive device (β = 4.09; P = 0.033) and Internet use (β = 11.9; P = 0.017) were associated with higher reported CI, while employment correlated with reduced CI (β = ?7.97; P < 0.0001). None of the cognitive activities surveyed were found to reduce CI.

Discussion: This study did not identify a significant impact of cognitively enriching activities on reducing CI, suggesting that other prophylactic or therapeutic approaches should be investigated. A small portion of the population surveyed reported no or minimal CI, suggesting the existence of a resilient population.     

Glycyrrhizic acid exerts anti-inflammatory effect to improve cerebral vasospasm secondary to subarachnoid hemorrhage in a rat model

This study aimed to investigate the therapeutic effect of glycyrrhizic acid (GA) on the cerebral vasospasm (CVS) in a rat subarachnoid hemorrhage (SAH) model and to explore the potential mechanism. A total of 44 healthy male rats were randomly assigned into 3 groups: control group (n = 12), SAH group (n = 16) and GA group (n = 16). No treatment was conducted in control group; in SAH group and GA group, experimental CVS was induced using a double-hemorrhage model and then rats were intraperitoneally injected with normal saline and GA at 10 mg/kg, respectively, once daily. Three days later, neurological function was evaluated. Then, animals were sacrificed, and the basilar artery was collected. The inner diameter and vascular wall thickness were determined. Western blotting was employed to detect high mobility group protein B1 (HMGB1) protein expression and RT-PCR to detect the mRNA expression of IL-1β, IL-6, TNF-α, and IL-10 in the basilar artery. GA treatment significantly improved the neurological function following SAH. In GA group, the basilar artery diameter increased markedly and vascular wall thickness reduced significantly when compared with SAH group (p < 0.05). HMGB1 protein expression and mRNA expression of IL-1β, IL-6, TNF-α, and IL-10 in SAH group were significantly higher than in control group (p < 0.05). However, GA dramatically reduced IL-1β, IL-6, and TNF-α, and further elevated IL-10 expression as compared to SAH group (p < 0.05). GA may inhibit HMGB1 expression and subsequent production of inflammatory cytokines to prevent CVS following SAH.