Chronic idiopathic axonal polyneuropathy and successful aging of the peripheral nervous system in elderly people

BACKGROUND: Chronic idiopathic axonal polyneuropathy (CIAP) is a frequent neurologic disorder in elderly persons. In view of the aging population, it is important to know the long-term prognosis of CIAP. OBJECTIVES: To determine if CIAP is influenced by the superposition of the effects of aging and to evaluate the severity of CIAP according to the disease duration. DESIGN: Controlled cohort study. SETTING: Outpatient clinic for neuromuscular diseases at the University Medical Center Utrecht, Utrecht, the Netherlands. PARTICIPANTS AND METHODS: One hundred twenty-seven patients with CIAP and 108 age-matched control subjects were included. We defined CIAP on the basis of symmetrical distal sensory or sensorimotor symptoms and signs with evolution over at least 6 months, exclusion of causes by history taking, results of clinical and laboratory investigations, and electrophysiologic findings that agreed with the diagnosis of axonal polyneuropathy. RESULTS: No important neurologic or electrophysiologic differences were found between patients with early-onset (before the age of 65 years) and late-onset (at or after the age of 65 years) CIAP, but patients with early-onset CIAP who had a short disease duration (<10 years) experienced more disability than patients with late-onset CIAP who had a similar disease duration. Old controls (age of 65 years or older) more often had symptoms, sensory signs in the legs, absent ankle jerks, and lower mean distal amplitudes of compound muscle action potentials and sensory nerve action potentials than young controls (aged <65 years). Absence of the sural nerve sensory nerve action potentials or presence of spontaneous muscle fiber activity in the anterior tibial muscle was common in patients with CIAP (51% and 60%, respectively), but exceptional (both 2%) in controls. CONCLUSIONS: Neither aging of the peripheral nervous system nor disease duration affects CIAP to a considerable degree, but CIAP has a greater influence on the daily life of nonretired patients with early-onset CIAP. The diagnosis of axonal polyneuropathy is probably supported best by either the absence of the sural nerve sensory nerve action potentials or the presence of spontaneous muscle fiber activity in the anterior tibial muscle.     

Fatigue mediates the relationship between physical fitness and quality of life in cancer survivors

ObjectivesThis study aims to investigate whether fatigue mediates the association between physical fitness and quality of life.DesignUncontrolled pre–post intervention design.MethodsPre- and post-intervention measurements were conducted in 119 patients who completed chemotherapy treatment for various types of cancer. The intervention was an 18-week exercise programme consisting of high-intensity resistance and interval training. We assessed physical fitness – peak oxygen uptake and peak power output – self-reported fatigue (Multidimensional Fatigue Inventory – subscales general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue-, and fatigue symptom scale of EORTC QLQ-C30) and quality of life (EORTC QLQ-C30, subscale global quality of life). Linear regression analyses were conducted on the residual change scores of the variables. The mediated effect of fatigue on the association between physical fitness and quality of life was examined using the products of coefficient method. Bootstrapping was used to calculate the confidence intervals.ResultsWe found significant associations between changes in physical fitness and global quality of life, between physical fitness and fatigue, and between fatigue and global quality of life. General fatigue mediated the positive association between peak power output and global quality of life, accounting for 82% of the total association. Physical fatigue, reduced activity, reduced motivation, and fatigue symptom were also mediators of this association. The mediation effects accounted for 91%, 76%, 38% and 71% of the total association, respectively. Reduced activity and reduced motivation mediated the association between peak oxygen uptake and global quality of life. Multiple mediation analyses showed that physical aspects of fatigue were stronger mediators than mental aspects.ConclusionsGeneral fatigue and physical aspects of fatigue mediate the relationship between physical fitness and quality of life in cancer survivors. We found no mediating effect of mental fatigue.     

Effects of exercise in patients treated with stem cell transplantation for a hematologic malignancy: A systematic review and meta-analysis

We performed a systematic review and meta-analysis evaluating the effectiveness of exercise interventions compared with usual care on physical fitness, fatigue and health-related quality of life in patients with hematologic malignancies treated with stem cell transplantation. Electronic databases were searched up to June 2012. We included randomized controlled trials comparing exercise with usual care, in which at least 75% of the patients had a hematologic malignancy. Standard mean differences were calculated and pooled to generate summary effect sizes (ES) and 95% confidence intervals (CI). The Cochrane Collaboration Risk of Bias Tool was used to assess the methodological quality of the studies.     

How disabling are pediatric burns? Functional independence in Dutch pediatric patients with burns

Although the attention for functional outcomes after burn injury has grown over the past decades, little is known about functional independence in performing activities of daily living in children after burn injury. Therefore, in this prospective cohort study functional independence was measured by burn care professionals with the WeeFIM(?) instrument in 119 pediatric patients with burns (age: 6 months-16 years; 58.8% boys) in the Netherlands. In order to identify whether functional independence was affected, participants' total scores on the WeeFIM(?) instrument were compared to American norm values. Of the participants assessed at 2 weeks post burn (n=117), 3 months post burn (n=68) and/or 6 months post burn (n=38), 22, 9 and 9 participants showed affected performance, respectively. Improvements in WeeFIM(?) total scores for the total study population between 2 weeks and 6 months post burn were significant (Wilcoxon T=2.5; p<.001, effect size=-0.59). Individual improvements were found to be significant for 30.3% of the assessed participants between 2 weeks and 3 months post burn, and for 12.1% between 3 and 6 months post burn. This study is unique in providing data on functional independence for this large and special population. However, a proportion of participants were lost to follow-up and the use of the WeeFIM(?) instrument in this specific population and setting has its limitations. To conclude, burn injury impacts functional independence in children, yet the vast majority of Dutch pediatric patients with burns returns to functional independence typical for age within 6 months post burn.     

Promoting physical activity in an adolescent and a young adult with physical disabilities

BackgroundWe sought to describe the design of the Active Lifestyle and Sports Participation (ALSP) intervention for adolescents and young adults with physical disabilities, and to present the first 2 cases.MethodsA 17-year-old boy with myelomeningocele and hydrocephalus and a 23-year-old woman with unilateral cerebral palsy were enrolled into the ALSP intervention, a personalized intervention designed to improve physical activity and fitness levels. Main outcome measures were self-reported physical activity and aerobic fitness. Fitness was determined by submaximal 6-minute walk or wheel test and by maximal cycle or arm ergometer-exercise test. Participants rated satisfaction with the intervention on a Likert-type numeric scale from 1 to 10.ResultsImprovements in self-reported physical activity were 51% and 75% for the male and female participant, respectively. Respective improvements in submaximal exercise were 16% and 9%. Maximal exercise increased 39% in the male participant but did not increase in the female participant. Satisfaction with the intervention was rated moderate-good to excellent.ConclusionData for the first 2 cases suggested that ALSP intervention seemed feasible to offer in an outpatient rehabilitation department, and the effectiveness may be promising. Future studies should determine the short- and long-term effectiveness of the intervention.     

A new intrasurgical technique to safely and reproducibly induce partial unilateral urinary obstruction and renal scarring in a Rat Model

International Urology and Nephrology - Irreversible electroporation (IRE) uses microsecond-long electric pulses to kill cells through membrane permeabilization, without affecting surrounding...