Estrogen replacement therapy in combination with continuous intrauterine progestin administration reduces the amount of circulating oxidized LDL in postmenopausal women: dependence on the dose of progestin

BACKGROUND: Oxidized low density lipoprotein (LDL) plays a key role in processes leading to atherosclerosis. Recent studies show that LDL oxidation in vitro is effectively prevented by estrogen. Yet, the effect of hormonal therapy (HT) on in vivo LDL oxidation has remained open. AIM: We used a novel methodology for the measurement of oxidized LDL in vivo in order to investigate the effects of HT. METHODS: The subjects were derived from two separate trials. In trial 1 (24 months) women (n = 32) used intra-uterine system releasing 10 micrograms/day levonorgestrel, and 2 mg oral estradiol. Trial 2 (12 months) consisted of two groups of subjects. One group (n = 30) used an intrauterine system releasing 20 micrograms/day levonorgestrel, and 2 mg estradiol; the other group (n = 32) received orally a combination of 1 mg norethisterone acetate and 2 mg estradiol. Blood samples were taken at 6 months intervals. Estimation of in vivo LDL oxidation was based on determination of baseline diene conjugation in isolated LDL. RESULTS: Hormonal therapy in trial 1 decreased markedly in vivo LDL oxidation. The effect was seen after 6 months' HT and became more pronounced towards the end of study (41% decrease; P < 0.0001). Contrary to this, in trial 2 the two different kinds of hormonal therapy schemes did not affect in vivo LDL oxidation. CONCLUSIONS: The strong effect seen in trial 1 shows that intrauterine levonorgestrel with 2 mg estradiol can lower LDL oxidation in vivo. The results show that this effect depends on dosage of the progestin.     

Relation of aromatase gene polymorphism and hormone replacement therapy to serum estradiol levels,bone mineral density,and fracture risk in early postmenopausal women*

BACKGROUND. After the menopause, estrogen synthesis from androgens and androgen precursors by aromatase is the main source of circulating estrogens. AIM. To evaluate whether aromatase gene (CYP19)polymorphism affects circulating estradiol (E[Formula: See Text])levels, bone mineral density (BMD), BMD change or fracture risk. METHODS. A 5-year randomized hormone replacement therapy (HRT) trial on 331 early postmenopausal women (mean baseline age 52.7?±?2.3 years). The participants consisted of two treatment groups: the HRT group (n?=?151) received a sequential combination of 2?mg estradiol valerate and 1?mg cyproterone acetate with or without vitamin D[Formula: See Text], 100-300?IU?+?93?mg calcium as lactate/day, and the non-HRT group (n?=?180) received 93?mg calcium alone or in combination with vitamin D[Formula: See Text], 100-300?IU/day for 5 years. BMD was measured from lumbar spine and proximal femur (DXA) before and after the 5-year trial. All new symptomatic, radiographically defined fractures were recorded during the follow-up. The polymorphism (intron 4 TTTA repeat) of CYP19 was evaluated after PCR amplification of the polymorphic site. CYP19 polymorphism was divided into three repeat groups: short (length of 7 or 8 in both alleles; n?=?135), long (length of 11 or higher in both alleles; n?=?47), and medium (rest of the values; n?=?149). RESULTS. Of the baseline characteristics, only physical activity was associated with CYP19 polymorphism (P?=?0.04) and a borderline significance was observed with previous fractures (P?=?0.05). In the HRT or non-HRT groups, the 5-year serum E[Formula: See Text] change was not associated with CYP19 polymorphism (P?=?0.87 and 0.74, respectively). Further, the polymorphism did not influence the calculated annual changes of lumbar or femoral neck BMD during the 5-year follow-up in the HRT (P?=?0.60 and 0.17, respectively) or non-HRT (P?=?0.92 and 0.80, respectively) groups. In all, 28 women sustained 33 fractures during the follow-up. The CYP19 polymorphism was not significantly associated with fracture risk (P?=?0.89 and 0.23 respectively; Cox proportional hazards model) in the HRT or non-HRT groups. CONCLUSIONS.CYP19 polymorphism was not associated with circulating E[Formula: See Text] levels, BMD values, or fracture risk in these early postmenopausal Finnish women. If such an association exists in women, it may become apparent in older age groups.     

Exploring with [18F]UCB-H the in vivo Variations in SV2A Expression through the Kainic Acid Rat Model of Temporal Lobe Epilepsy

Purpose

The main purpose of this study was to understand how the positron emission tomography (PET) measure of the synaptic vesicle 2A (SV2A) protein varies in vivo during the development of temporal lobe epilepsy (TLE) in the kainic acid rat model.

Procedures

Twenty Sprague Dawley male rats were administered with multiple systemic doses of saline (control group, n?=?5) or kainic acid (5 mg/kg/injection, epileptic group, n?=?15). Both groups were scanned at the four phases of TLE (early, latent, transition, and chronic phase) with the [¹⁸F]UCB-H PET radiotracer and T2-structural magnetic resonance imaging. At the end of the scans (3 months post-status epilepticus), rats were monitored for 7 days with electroencephalography for the detection of spontaneous electrographic seizures. Finally, the immunofluorescence staining for SV2A expression was performed.

Results

Control rats presented a significant increase in [¹⁸F]UCB-H binding at the last two scans, compared with the first ones (p?<?0.001). This increase existed but was lower in epileptic animals, producing significant group differences in all the phases of the disease (p?<?0.028). Furthermore, the quantification of the SV2A expression in vivo with the [¹⁸F]UCB-H radiotracer or ex vivo with immunofluorescence led to equivalent results, with a positive correlation between both.

Conclusions

Even if further studies in humans are required, the ability to detect a progressive decrease in SV2A expression during the development of temporal lobe epilepsy supports the use of [¹⁸F]UCB-H as a useful tool to differentiate, in vivo, between healthy and epileptic animals along with the development of the epileptic disease.

     

High C‐reactive protein levels are associated with oral hormonal menopausal therapy but not with intrauterine levonorgestrel and transdermal estradiol

Objective. Oral hormone replacement therapy (HRT) has been linked to increased cardiovascular (CVD) morbidity. HRT causes a sustained increase in C‐reactive protein (CRP), an excellent marker of subclinical inflammation and CVD. The aim of the study was to support our hypothesis that CRP, which is synthesized in the liver, is not increased in association with transdermal/intrauterine HRT. Material and methods. A case‐control study was performed in which CRP measurements in women receiving levonorgestrel intrauterine system combined with transdermal estradiol (LNG/TDE, n = 27) were followed for 9 months or longer. CRP concentrations in these women were compared with those of either oral HRT users (n = 20) or controls (n = 19). Results. No significant differences were found in CRP concentrations between the LGN/TDE and control groups (1.8±1.2 and 1.8±1.8?mg/L, respectively). However, CRP was significantly increased in the oral HRT group (5.5±2.9?mg/L, p<0.001). Conclusions. CRP is significantly increased by oral HRT but not by the LNG/TDE combination after 9 months of treatment. This trend may explain the preponderance of some menopausal women on HRT being at increased risk for the development of CVD. Therefore, the use of LNG/TDE is acceptable for relief of severe climacteric symptoms possibly not imposing an increased CVD risk documented upon oral HRT.     

Postmenopausal estrogen therapy and serum estradiol fatty acid esters in women with and without previous intrahepatic cholestasis of pregnancy

BACKGROUND. Fatty acid esters of 17β‐estradiol (E2) are estrogen metabolites associated with lipoproteins in blood.

AIM. To study the effects of estrogen therapy on concentrations of serum E2 fatty acid esters in postmenopausal women with a history of an estrogen‐related liver disorder, intrahepatic cholestasis of pregnancy (ICP), and in healthy women in a double‐blind, crossover fashion.

METHOD. ICP (n?=?10) and control women (n?=?10) received increasing doses of E2 valerate orally 2–4?mg/day, or transdermal E2 50–100?μg/day for 6 weeks. After a 4‐week wash‐out period, the subjects crossed over to the alternate E2 treatment. Concentrations of serum E2 fatty acid esters were quantified after saponification by fluoroimmunoassay.

RESULTS. Oral E2 administration increased median serum E2 fatty acid ester concentrations from 57 to 73?pmol/L in the ICP and from 56 to 74?pmol/L in the control group, in association with elevations in serum E2, estrone and sex hormone‐binding globulin levels. Transdermal E2 treatment did not increase serum E2 ester levels.

CONCLUSIONS. The increase in serum E2 fatty acid esters during oral E2 administration may be attributed, at least partly, to the higher estrogen dose during oral compared with transdermal therapy. A history of ICP did not affect esterification of E2 during estrogen therapy.     

Safety and effectiveness of physostigmine: a 10-year retrospective review*

Background: Physostigmine has long been recognized as an antidote to reverse anticholinergic delirium. However, its effectiveness, safety profile, and dosing have been disputed.

Objectives: To describe effectiveness, adverse events, and dosing associated with the use of physostigmine to reverse anticholinergic delirium.

Methods: A retrospective cohort study of hospitalized patients reported to a regional poison center system between 2003 and 2012 who received physostigmine to reverse an anticholinergic toxidrome. Data extraction of a priori defined variables were recorded with concurrence of investigators. The cases were stratified by the primary ingestant as the presumed causative agent and associations for response were performed using odds ratios (ORs), 95% confidence intervals (CI’s), and p values.

Results: Of the 1422 cases identified, 191 met the inclusion criteria. Patients exposed to non-diphenhydramine antihistamines (n?=?14), antipsychotics (n?=?4), and tricyclic antidepressants (n?=?3) had 100% response to physostigmine, whereas anticholinergic plants (n?=?46/67; 68.7%, OR: 0.70; CI: 0.36–1.35), diphenhydramine (n?=?43/56; 64.2%, OR: 1.30; CI: 0.63–2.68), and combination products (n?=?8/10; 80%, OR: 1.48; CI: 0.30–7.24) had partial response rates. Of the included patients, 142 (74.3%) were treated with physostigmine alone, and 16 (8.4%) of these patients were discharged directly from the emergency department (ED).

Discussion: Most patients, 182 (95.3%), had no documented adverse effects. Four patients (2.1%) experienced emesis, two experienced QTc prolongation (1.0%), and two experienced seizures (1.0%). There was a single fatality 6?h after physostigmine administration. Average initial total doses of physostigmine ranged from 1.0 to 1.75?mg. Most patients were admitted to the ICU (n?=?110; 57.6%), however, 36 (18.8%) patients were discharged directly from the ED.

Conclusions: In this retrospective cohort study, physostigmine administration to reverse anticholinergic delirium had a good safety profile, and often improved or resolved anticholinergic delirium when administered in doses less than 2?mg.     

Changes in peripheral blood T-cell balance after percutaneous tumor ablation

Purpose: To evaluate the changes in T-cell balance in peripheral blood following percutaneous tumor ablation.

Material and methods: Patients underwent thermal ablation including radiofrequency (n?=?9) and microwave ablation (n?=?5), or cryoablation (n?=?5). Target tumors were located in the lung (n?=?7), soft tissue (n?=?5), liver (n?=?4), and bone (n?=?3). Patient peripheral blood samples were collected before and within 14?days after ablation. Peripheral blood populations of cytotoxic T-cells (CTL), type-1 (T_h1) and type-2 helper T-cells (T_h2), and regulatory T-cells (T_reg) were measured using flow cytometry. Changes in CTL/T_reg and T_h1/T_h2 ratios before and after ablation therapy were compared using paired t-tests.

Results: Peripheral blood CTL population (27.5?±?2.1% to 30.2?±?2.5%, p?reg ratios (18.8?±?3.7% to 21.6?±?3.6%, p?reg ratios was found after heat-based ablation (18.0?±?4.4% to 21.6?±?4.7%, p?p?=?.92). T_h1/T_h2 ratio (13.7?±?3.0% to 17.2?±?3.5%, p?=?.12) remained unchanged after ablation.

Conclusion: Ablation therapy alters the T-cell balance by increasing the systemic CTL/T_reg, ratio. Heat-based ablation might be a more effective approach than cryoablation to enhance systemic anti-tumor immunity.     

Evaluation of Clostridium difficile Infection with PET/CT Imaging in a Mouse Model

Purpose

Existing clinical or microbiological scores are not sensitive enough to obtain prompt identification of patients at risk of complicated Clostridium difficile infection (CDI). Our aim was to use a CDI animal model to evaluate 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission tomography ([¹⁸F]FDG-PET) as a marker of severe course of infection.

Procedures

CDI was induced with cefoperazone for 10 days followed by clindamycin 1 day before C. difficile inoculation. Mice were divided into wild type (n?=?6), antibiotic without infection (AC n?=?4), h001-infected (n?=?5, ribotype 001), and h027-infected (n?=?5, ribotype 027). Two days after inoculation, [¹⁸F]FDG-PET was acquired. Weight, general animal condition, and survival were monitored daily for 9 days.

Results

h001 group showed symptoms for 4 days with 0 % mortality and a similar colon uptake than control animals (h001 0.52?±?0.20, WT 0.42?±?0.07, and AC 0.36?±?0.06). The h027 group showed symptoms up to 7 days, with 66.7 % of mortality 4 days after infection, and significantly higher colon uptake (0.93?±?0.38, p?<?0.05). Clinical score was associated to colon and cecum uptake (rho?=?0.78, p?=?0.0001) (rho?=?0.73, p?=?0.0003).

Conclusion

High toxin producer ribotype 027 induced more severe CDI infections, correlating with higher colon and cecum [¹⁸F]FDG uptake. Colon uptake may purportedly serve as early predictor of CDI severity.

     

Management of severe pain after dermal contact with caterpillars (erucism): a prospective case series

Context: Erucism, envenomation caused by dermal contact with larval forms of moths, may result in intense local pain, mainly after contact with puss caterpillars (family Megalopygidae).

Objective: To evaluate the response to different treatments for controlling severe pain in a case series of erucism in Campinas, southeastern Brazil.

Patients and methods: Prospective cohort study. A Numeric Pain Rating Scale (NPRS 0–10) was used to assess pain intensity in the Emergency Department (ED). Pain was considered as severe upon ED admission (T0) when the NPRS was ≥8. Inclusion criteria: age ≥8 years old, severe pain at T0, with continuous assessment of pain intensity in all patients using the NPRS during the ED stay (T5, T15, T30, T60?min and at discharge).

Results: Fifty-five patients fulfilled the inclusion criteria and were divided into three groups according to the initial treatment at T0: local anesthesia alone with 2% lidocaine (group 1, n?=?15), local anesthesia and analgesics (group 2, n?=?26) and analgesics without local anesthesia (group 3, n?=?14). Most patients were admitted within 2?h after dermal contact with the stinging bristles of caterpillars (median =90?min, IQR: 40–125?min). In 22 cases (40%), the caterpillar was brought for identification (Podalia spp., n?=?18; Megalopyge spp., n?=?4). There was a significant decrease in pain from T5 onwards with all of the treatments. When the short-term response (T5 and T15) was considered, analgesia was more effective in groups 1 and 2 compared to group 3 (p?n?=?25/55), mainly in group 1 (n?=?11/15). The median length of stay in the ED was 120?min (IQR: 80–173?min).

Conclusions: The association of local anesthesia with analgesics was apparently a good combination for the rapid management of severe pain in the ED.     

Contrast-enhanced ultrasonography for blood flow detection in hepatocellular carcinoma during lenvatinib therapy

Purpose

Blood flow reduction after initiation of lenvatinib therapy may not always indicate tumor necrosis. This study aimed to compare the blood flow detectability of contrast-enhanced ultrasonography (CEUS), contrast-enhanced computed tomography (CT), and contrast-enhanced magnetic resonance imaging (MRI) in hepatocellular carcinoma (HCC) during lenvatinib therapy.

Methods

A total of 12 cases underwent CEUS and contrast-enhanced CT/MRI within 2 weeks during lenvatinib therapy. Vascularity on CEUS and CT/MRI was compared.

Results

At the time of CEUS examination, the median period from the start of lenvatinib was 227?±?210 (31–570) days. CEUS showed hyperenhancement in eight cases (66.7%), hypoenhancement in two cases (16.7%), and no enhancement in one case (8.3%), while CT/MRI showed hyperenhancement in one case (8.3%), ring enhancement in three cases (25.0%), and hypoenhancement in eight cases (66.7%) (p?=?0.007). Transarterial chemoembolization (n?=?3), radiofrequency ablation (n?=?2), and stereotactic body radiation therapy (n?=?2) were performed after blood flow detection by CEUS.

Conclusions

The viability of the HCC should be confirmed using CEUS when contrast-enhanced CT/MRI reveals lesion hypoenhancement during lenvatinib therapy.

     

Exploring the ecological validity and variability of a 10-min bout of wheeling

Purpose: To determine the ecological validity of using able-bodied participants to perform a 10-min wheeling trial by (1) evaluating changes in biomechanics over the trial in manual wheelchair users and able-bodied participants naïve to wheeling and (2) describing differences in changes and variability between groups.

Materials and methods: Manual wheelchair users (n?=?7, 2–27?years’ experience) and able-bodied participants (n?=?11) wheeled for 10?min. Kinetic and temporal variables were collected and averaged over each minute, while wheeling strategy (movement pattern) was categorized at minutes 1 and 10.

Results: There was a main effect of time for push angle, and a main effect of group for average push angle, tangential force and total force. Manual wheelchair users used larger push angles and forces compared to able-bodied participants. Surprisingly, intercycle variability did not differ between groups.

Conclusion: Using able-bodied participants to represent manual wheelchair users performing a 10-min wheeling trial is not ecologically valid and caution should be used when interpreting push angle and forces applied to the pushrim. Considering that push angle was the only variable that demonstrated a main effect of time, long durations (e.g., 10?min) of wheeling may be appropriate for use in study designs acknowledging potential changes in wheeling strategy and push angle.

• Implications for Rehabilitation

• Some experienced wheelchair users and non-wheelchair users modify their movement pattern from an arc to a circular pattern within a 10-min wheeling trial.

• There are clear biomechanical differences in push angle and forces applied to the pushrim between wheelchair users with experience and able-bodied non-wheelchair users.

• Able-bodied participants who have no prior manual wheeling experience are no more variable than long-term wheelchair users.

• Variability may play an important role in wheelchair propulsion.

     

Comparison of the Poisoning Severity Score and National Poison Data System schemes for the severity assessment of animal poisonings: a pilot study

Context: To date, there are no publicly available schemes designed and evaluated specifically for severity assessment of animal poisonings. This poses challenges for the evaluation and comparison of animal poisoning exposure data.

Objective: Our objective for this pilot study was to evaluate agreement between raters using the Poisoning Severity Score (PSS) and National Poison Data System (NPDS) medical outcome scheme for severity assessment of canine exposures reported to a multistate poison center (PC) and to identify issues regarding their use for severity assessment of animal poisonings. Agreement between both schemes was also assessed.

Methods: The first 196 canine exposures reported to a multistate PC between 1 January and 31 August 2016 were selected and initial inquiry data from exposures was scored by four independent raters. Interrater agreement and agreement between the severity systems was calculated using weighted kappa (Κ) (Light’s kappa). Reported clinical effects were also described.

Results: Interrater agreement for both the PSS (Κ 0.31; 95% CI 0.19, 0.43) and NPDS schemes (Κ 0.34; 95% CI 0.22, 0.44) was low. Agreement between the schemes was slight (Κ 0.05; 95% CI ?0.08, 0.16) for pooled results from all four raters. For the PSS, 71.7% (n?=?281) of ratings were minor, 23.0% (n?=?90) moderate, and 5.4% (n?=?21) severe. For the NPDS, 69.6% (n?=?273) of ratings were minor, 27.0% (n?=?106) moderate, and 3.3% (n?=?13) severe. The top three reported clinical effects included vomiting (n?=?86, 29.9%) drowsiness/lethargy (n?=?38, 13.2%), and diarrhea (n?=?24, 8.3%).

Discussion and conclusions: This study shows considerable variability between raters using either the PSS or NPDS schemes for canine exposures severity assessment. The subjective nature of the schemes, the influence of intra- and interrater variation, and predominance of minor cases on the study findings should be taken into account when interpreting this data. Further evaluation of these schemes is warranted and could help inform their future use for animal poisoning severity assessment.     

Development of a family-based pulmonary rehabilitation programme: an exploratory study

Abstract

Purpose: This study explored the expectations of patients with chronic obstructive pulmonary disease (COPD) and family members about a family-based pulmonary rehabilitation (PR) programme; developed and implemented a family-based PR programme and explored the impacts of the intervention on patients and family members. Method: Patients with COPD and family members were interviewed. A family-based PR programme was designed. Patients' breathlessness, muscle strength, exercise tolerance, functional balance and health-related quality of life were collected pre/post-programme. Family coping and adjustment to illness were measured in patients and family members. Focus groups were conducted after the programme. Results: Patients (n?=?35; 69?±?10 years; FEV₁ 62?±?15% predicted) and family members (n?=?35; 57?±?12 years) had similar expectations/needs about a PR programme. Nine dyads participated. Patients' quadriceps strength, exercise tolerance and functional balance improved significantly (all p values?<?0.023). Patients and family members seem to use more positive coping behaviours (p?=?0.026; p?=?0.011). Patients (n?=?7; 78%) and family members (n?=?8; 89%) considered having more knowledge about COPD and its management. Patients felt more functional (n?=?9; 100%) and reported their family members to be more active (n?=?3; 38%). In family members' perspective, their relationship with the care receiver was enhanced (n?=?2; 22%). Conclusions: PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD.

• Implications for Rehabilitation

• Patients with chronic obstructive pulmonary disease (COPD) and their family members have similar expectations and needs about a family-based pulmonary rehabilitation (PR) programme.

• A family-based PR programme is feasible to implement within primary care.

• PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD.

     

The effectiveness of mental imagery for improving strength in an asymptomatic population

Abstract

Background:

Strength training is one focus for physiotherapy management to help restore function. However, conventional strength training requiring an active muscular contraction is not always possible. Mental imagery (MI) has been proposed as a viable alternative to strength training without the need for actual movement.

Objective:

To investigate whether MI is effective in achieving strength gains in an asymptomatic population.

Methods:

A systematic review of key databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and risk of bias assessed using Grading of Recommendations Assessment, Development and Education (GRADE). Studies were included if they were a randomised control trial (RCT), clinical control trial (CCT) or pre-post study investigating the effect of an MI protocol for improving strength in asymptomatic adult populations.

Results:

From 639 articles, 28 full texts were assessed and six were included for review. These studied effect of MI on strength improvements for 5th finger abductors (n?=?53), quadriceps (n?=?51), elbow flexors (n?=?51), ankle dorsiflexors (n?=?51) and plantarflexors (n?=?51). Strength gains were reported in all muscle groups with the exception of elbow flexors. MI may be more effective for muscle groups with larger motor cortex representation, especially 5th finger abductors.

Conclusion:

The findings suggest that a course of MI can increase strength greater than a control group but less than a physical practice (PP) group within this population. The findings of this study provide promising clinical implications for use of MI for improvements or maintenance of strength within a patient group unable to actively strengthen due to pain or immobilisation.     

雌二醇凝胶在中-重度宫腔粘连电切术后的应用价值研究

目的 比较雌二醇凝胶和戊酸雌二醇片在中-重度宫腔粘连(IUA)电切术后患者中的临床疗效,探索雌二醇凝胶在宫腔镜下IUA电切术(TCRA)后的应用价值.方法 回顾性分析2018年1月-2020年1月该院行TCRA的213例中-重度IUA患者的临床资料,根据术后药物剂型和给药途径不同,将患者分为经皮组(n=109)和口服组...     

Integrative group-based cognitive rehabilitation efficacy in multiple sclerosis: a randomized clinical trial

Purpose: This study aimed to determine the efficacy of the integrative group-based cognitive rehabilitation programme, REHACOP, on improving cognitive functions in multiple sclerosis (MS).

Methods: Fourty-two MS patients were randomized to the treatment programme REHACOP (n?=?21) or waiting list control condition (n?=?21). The REHACOP group received cognitive rehabilitation in group format for three months focused on attention, processing speed, learning and memory, language, executive functioning, and social cognition. Patients completed a neuropsychological assessment at baseline and follow-up, which included tests of attention, processing speed, working memory, verbal memory, verbal fluency, and executive functioning. Repeated measures multivariate analysis of covariance (MANCOVA) was used to determine the efficacy of the cognitive rehabilitation programme.

Results: Group?×?Time interactions revealed significant improvements in the REHACOP group as compared with the control group for processing speed (p?=?0.011, n_p²?=?0.16), working memory (p?=?0.014, n_p²?=?0.15), verbal memory (p?=?0.025, n_p²?=?0.13), and executive functioning (p?=?0.024, n_p²?=?0.13), showing medium–large effect sizes.

Conclusions: Patients receiving REHACOP showed improvements in several cognitive domains. This preliminary study thus provides evidence supporting the efficacy of this integrative group-based cognitive rehabilitation intervention in MS. Future research should confirm these findings, examine the impact of the treatment on everyday life functioning and explore the presence of brain changes associated with cognitive rehabilitation.

• Implications for rehabilitation

• This study provides initial evidence for integrative group-based cognitive rehabilitation efficacy in MS patients through the implementation of the REHACOP cognitive rehabilitation programme.

• Patients received cognitive rehabilitation for three months (3 one-hour-sessions per week) focused on training attention, learning and memory, language, executive functioning, and social cognition.

• Patients attending REHACOP sessions showed medium to large and statistically significant improvements in processing speed, working memory, verbal memory, and executive functioning.

     

Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy

Purpose: We investigated if 30?min of daily treadmill training with an incline for 6 weeks would reduce ankle joint stiffness and improve active range of movement in adults with cerebral palsy (CP).

Methods: The study was designed as a randomized controlled clinical trial including 32 adults with CP (GMFCS 1–3) aged 38.1 SD 12 years. The training group (n?=?16) performed uphill treadmill training at home daily for 30?min for 6 weeks in addition to their usual activities. Passive and reflex mediated stiffness and range of motion (ROM) of the ankle joint, kinematic and functional measures of gait were obtained before and after the intervention/control period. Intervention subjects trained 31.4 SD 10.1 days for 29.0 SD 2.3?min (total) 15.2?h.

Results: Passive ankle joint stiffness was reduced (F?=?5.1; p?=?0.031), maximal gait speed increased (F?=?42.8, p?F?=?5.3, p?F?=?12.5; p?Conclusion: Daily treadmill training with an incline for 6 weeks reduces ankle joint stiffness and increases active ROM during gait in adults with CP. Intensive gait training may thus be beneficial in preventing and reducing contractures and help to maintain functional gait ability in adults with CP.

• Implications for rehabilitation

• Uphill gait training is an effective way to reduce ankle joint stiffness in adult with contractures.

• 6 weeks of daily uphill gait training improves functional gait parameters such as gait speed and dorsal flexion during gait in adults with cerebral palsy.

     

CT fluoroscopy-guided percutaneous drainage: comparison of the one step and the Seldinger techniques

Objective: To evaluate the one step technique compared with the Seldinger technique in computed tomography (CT) fluoroscopy-guided percutaneous drainage of abdominal and pelvic abscess.

Material and methods: Seventy-six consecutive patients (49 men, 27 women; mean age 63.5 years, range 19–87 years) with abdominal and pelvic abscess were included in this study. Drainages were performed with the one step (n?=?46) and with the Seldinger (n?=?48) technique between September 2012 and June 2014.

Results: The technical success and clinical success rates were 95.8% and 93.5%, respectively, for the one step group, and 97.8% and 95.7%, respectively, for the Seldinger group. The mean procedure time was significantly shorter with the one step than with the Seldinger method (15.0?±?4.3?min, range 10–29?min vs. 21.0?±?9.5?min, range 13–54?min, p?Conclusion: The one step technique was easier and faster than the Seldinger technique. The effectiveness of both techniques was similar for the CT fluoroscopy-guided percutaneous drainage of abdominal and pelvic abscess.