Self-rehabilitation combined with botulinum toxin to improve arm function in people with chronic stroke. A randomized controlled trial

BackgroundBotulinum toxin injection (BTI) reduces muscle hyperactivity, but its effect on active upper-limb function is limited. Intensive rehabilitation could optimize the effects; however, outpatient post-stroke rehabilitation is usually not intensive. One solution could be self-rehabilitation.ObjectivesThe aim of this randomized controlled trial was to determine the effect of a self-rehabilitation program combined with BTI on upper-limb function in individuals with chronic hemiparesis.MethodsIn total, 33 outpatients were randomly allocated to receive BTI + self-rehabilitation (R group: n = 17) or BTI alone (C group: n = 16). Outcomes evaluated just before the BTI and 4 weeks later included the Wolf Motor Function Test (WMFT time: primary outcome), Action Research Arm Test, fatigue and quality of life.ResultsChange in WMFT did not differ between groups at 4 weeks (WMFT time: ?14% for R group, ?4% for C group. WFMT score: +12% for R group, 0% in C group). WFMT time and score improved significantly in the R group only (?14%, P = 0.01, and +12%, P = 0.02). In addition, the proportion of patients with improved WMFT time and score was higher in the R than C group (R group: 71% improved score, 77% improved time; C group: 43% improved score, 50% improved time). Also, passive range of shoulder flexion (P = 0.03) and wrist extension (P = 0.01) improved only in the R group. No other variables changed significantly. Compliance was excellent; average daily training time was greater than that prescribed.ConclusionsThe addition of a self-rehabilitation program to BTI did not significantly improve functional outcomes more than BTI alone; however, movement quality and speed improved only in the self-rehabilitation group. Participants in the self-rehabilitation group trained more than they were asked to, which suggests that they found the program worthwhile. These clinically relevant findings justify larger-scale studies of the effects of self-rehabilitation to enhance the effects of BTI. Clinical trial: NCT02699762.     

Crohn’s disease: multi-detector row CT-enteroclysis appearance of the appendix

The objective of our retrospective study was to determine the MDCT-enteroclysis appearance of the appendix in patients with Crohn’s disease and to correlate this appearance with the status of the disease. We reviewed the MDCT-enteroclysis examinations of 76 patients with Crohn’s disease. Images were analyzed for visualization of the appendix, largest axial diameter of the appendix and degrees of enhancement. Findings were correlated with the status of the disease (active vs. nonactive) and compared with those observed in a control group. Among the various variables, hyperenhancement of the appendiceal wall was found in 18.9% of patients with active disease and in no patients with inactive disease nor in the control group (P = 0.0023). This sign had a specificity of 100% for differentiating between active and inactive Crohn’s disease. We conclude that increased appendiceal wall enhancement is, at a statistically significant level, more frequently observed in patients with active Crohn’s disease by comparison with patients with inactive disease and control subjects. This result suggests that this finding may be used as an additional MDCT-enteroclysis finding to determine the activity of the disease.     

Occurrence of Adverse Events in Long-Term Intrathecal Baclofen Infusion: A 1-Year Follow-Up Study of 158 Adults

Objective

To assess the frequency and types of adverse events (AEs) related to intrathecal baclofen (ITB) therapy in adults, and associated risk factors.

Design

A prospective, observational cohort study of adults followed up from January 1 to December 31, 2010.

Setting

A neurologic rehabilitation department in a university hospital.

Participants

All consecutive adult subjects (N=158) receiving ITB via a pump, either implanted or followed up during the study period.

Intervention

Not applicable.

Main Outcome Measures

Frequency and type of AEs.

Results

In 2010, 158 subjects were followed up for ITB therapy, of whom 128 were implanted before 2010 (nonsurgical subjects), and 30 underwent implantation in 2010 (surgical subjects). Of these 30 subjects, 20 were “newly implanted” and 10 were “replacements.” The most frequent pathologic disorders were spinal cord injury (42%) and multiple sclerosis (28%). Twenty-eight subjects (18%) experienced a total of 38 AEs. The rate of AEs was .023 per month of ITB treatment. AEs were related to the surgical procedure in 53% of cases, to the device in 29% (predominantly catheter dysfunctions), and to adverse effects of baclofen in 18%. AEs related to the surgical incision (scar complications and collections) were more frequent in replacement than newly implanted subjects (P=.009). No significant association between occurrence of an AE and subject characteristics (age, gait capacity, spinal vs cerebral spasticity, duration of ITB therapy follow-up) was found. Nearly half of the AEs were serious, extending admission time by a mean of 16 days. No AE induced long-term morbidity or death.

Conclusions

The AE rate was relatively low in this cohort. This has to be balanced against the clinical, functional, and quality-of-life improvements, which are expected from ITB therapy.     

Annoyance Caused by Exposure to Road Traffic Noise: An Update

This paper addresses the negative effects resulting from the exposure to road traffic noise on people's well being with a focus on annoyance. Following the observations that noise exposures engender physiological reactions typical of stress, the non-auditory effects of noise on humans are generally viewed as being stress-related, and annoyance is one of the first and most direct reactions to environmental noise. In general terms, it is found that the continuous exposure of people to road traffic noise leads to suffering from various kinds of discomfort thus reducing appreciably the number of their well being elements. However drawing such a conclusion is hindered by difficulties when non-acoustical factors like sensitivity, socio-economic situation and age are also taken into account along with the usual acoustical factors of road traffic noise. The results of several decades of research on this topic have permitted lately to establish a quantitative relationship between the objective quantities characterising road traffic noise, namely the day to night noise level, and the human subjective reaction to it as expressed by the percentage of highly annoyed people. These findings are important at both the society and the individual level in as much as they may help in regulating in a more efficient way the planning of road traffic activity in order to secure minimum comfort to the affected population.     

Synthesis of Schiff's base magnetic crosslinked chitosan-glyoxal/ZnO/Fe3O4 nanoparticles for enhanced adsorption of organic dye: Modeling and mechanism study

In this work, Schiff's base magnetic crosslinked chitosan-glyoxal/Fe₃O₄ composite (CS-G/Fe₃O₄) was synthesized and further developed by loading zinc oxide (ZnO) nanoparticles into its polymeric matrix. The final composite material of magnetic crosslinked chitosan-glyoxal/ZnO/Fe₃O₄ nanoparticles (CS-G/ZnO/Fe₃O₄ NPs) was tested for the removal of organic dye pollutant (reactive blue 19, RB19). The synthesized magnetic nanomaterials were characterized by several techniques such as CHN elemental analysis, Brunauer-Emmett-Teller analysis, vibrating-sample magnetometer, X–ray powder diffractometry, Fourier Transforms infrared, scanning electron microscope, energy dispersive X-Ray analysis, pH_pzc, and pH-potentiometric titrations. A statistical approach namely Box–Behnken design (BBD) was applied to optimize the synthesis conditions as well as adsorption key parameters (A: ZnO nanoparticles loading (0–50%), B: adsorbent dosage (0.02–0.1 g), C: pH (4–10), D: temperature (30–60 °C), and time E: (10–60 min)). The adsorption kinetic and equilibrium results were well described with pseudo-second order model and Freundlich isotherm model, respectively. The maximum adsorption capacity of CS-G/ZnO/Fe₃O₄ NPs for RB19 was 363.3 mg/g at 60 °C. The adsorption mechanism of RB19 onto CS-G/ZnO/Fe₃O₄ NPs can be ascribed to several types of interactions (e.g. electrostatic attractions, hydrogen bonding, and n-π interactions). This study provides a new and effective adsorbent for water remediation due to its recoverability and high efficiency in removing the organic dye pollutants.     

Non–C. difficile Clostridioides Bacteremia in Intensive Care Patients,France

Usually responsible for soft tissue infections, Clostridioides species can also cause bacteremia, life-threatening infections often requiring intensive care unit (ICU) admission. We conducted a multicenter retrospective study to investigate Clostridioides bacteremia in ICUs to describe the clinical and biologic characteristics and outcomes in critically ill patients. We identified 135 patients with Clostridioides bacteremia, which occurred almost exclusively (96%) in patients with underlying conditions. Septic shock and digestive symptoms were the hallmarks of Clostridioides bacteremia in the ICU. We identified 16 different species of Clostridioides, among which C. perfringens accounted for 31% of cases. Despite the high sensitivity of Clostridioides to common antimicrobial drugs, mortality rates were high: 52% for ICU patients and 71% overall at 3 months. In multivariate analysis, the most important factor associated with increased risk for death was the presence of hemolysis. Clostridioides bacteremia often leads to multiple organ failures, which have high mortality rates.     

Synthesis of Nano-Oxide Precipitates by Implantation of Ti,Y and O Ions in Fe-10%Cr: Towards an Understanding of Precipitation in Oxide Dispersion-Strengthened (ODS) Steels

The properties of oxide dispersion-strengthened steels are highly dependent on the nature and size distribution of their constituting nano-oxide precipitates. A fine control of the processes of synthesis would enable the optimization of pertinent properties for use in various energy systems. This control, however, requires knowledge of the precise mechanisms of nucleation and growth of the nanoprecipitates, which are still a matter of debate. In the present study, nano-oxide precipitates were produced via the implantation of Y, Ti, and O ions in two different sequential orders in an Fe-10%Cr matrix that was subsequently thermally annealed. The results show that the oxides that precipitate are not necessarily favoured thermodynamically, but rather result from complex kinetics aspects related to the interaction between the implanted elements and induced defects. When Y is implanted first, the formation of nanoprecipitates with characteristics similar to those in conventionally produced ODS steels, especially with a core/shell structure, is evidenced. In contrast, when implantation starts with Ti, the precipitation of yttria during subsequent high-temperature annealing is totally suppressed, and corundum Cr₂O₃ precipitates instead. Moreover, the systematic involvement of {110} matrix planes in orientation relationships with the precipitates, independently of the precipitate nature, suggests matrix restriction effects on the early stages of precipitation.     

Delayed haemolytic transfusion reaction in paediatric patients with sickle cell disease: A retrospective study in a French national reference centre

Delayed haemolytic transfusion reaction (DHTR) is a life-threatening haemolytic anaemia following red blood cell transfusion in patients with sickle cell disease, with only scarce data in children. We retrospectively analysed 41 cases of DHTR in children treated between 2006 and 2020 in a French university hospital. DHTR manifested at a median age of 10.5 years, symptoms occurred a median of 8 days after transfusion performed for an acute event (63%), before surgery (20%) or in a chronic transfusion programme (17%). In all, 93% of patients had painful crisis. Profound anaemia (median 49 g/L), low reticulocyte count (median 140 ×10⁹/L) and increased lactate dehydrogenase (median 2239 IU/L) were observed. Antibody screening was positive in 51% of patients, and more frequent when there was a history of alloimmunisation. Although no deaths were reported, significant complications occurred in 51% of patients: acute chest syndrome (12 patients), cholestasis (five patients), stroke (two patients) and kidney failure (two patients). A further transfusion was required in 23 patients and corticosteroids were used in 21 to reduce the risk of additional haemolysis. In all, 13 patients subsequently received further transfusions with recurrence of DHTR in only two. The study affords a better overview of DHTR and highlights the need to establish guidelines for its management in children.