Relationships between independence level of single motor-FIM items and FIM-motor scores in patients with hemiplegia after stroke: an ordinal logistic modelling study.

OBJECTIVE: To assess the relationships between independence levels of single motor-related Functional Independence Measure (FIM) items and summed FIM-motor scores of patients with hemiplegia after stroke. DESIGN: For each patient FIM scores were assessed 4 times during hospitalization. Ordinal logistic analyses were performed on group data. SUBJECTS: Fifty patients with hemiplegia after stroke staying in a long-term rehabilitation facility. RESULTS: Analyses revealed that FIM-motor scores accounted for much of the variability of independence levels for most of the single FIM items, including dressing upper body, and transfers to bed/chair/wheelchair and to toilet. For these items, the independence levels were proportionally associated with FIM-motor scores. For eating, higher FIM-motor scores (>60) were associated with modified independence and lower FIM-motor scores (<40) correlated with attainment of supervision/set-up levels. For dressing lower body, greater independence was apparent when FIM-motor scores were higher (>60). CONCLUSION: For single FIM items, relative difficulty was comparable with results from previous literatures using Rasch analyses. Moreover, our results revealed that relative difficulty for single items varied greatly between independence levels. With regard to disability task targets, probability of independence evaluated from logistic modelling is an aid to efficient rehabilitation scheduling.     

CD8+ T cell subsets of cytotoxic T lymphocytes induced by Epstein-Barr virus infection in infectious mononucleosis

Mononuclear peripheral blood lymphocytes (PBL) from patient with infectious mononucleosis (IM) were tested in a 51Cr-release assay for cytotoxicity against autologous and allogeneic lymphoblastoid cell line (LCL), or Epstein-Barr virus (EBV)-genome positive and negative cell line. In acute phase, PBL lyse an autologous LCL as well as allogeneic LCL (Wa cells). High levels of cytotoxicity were observed in the combinations between effector and target cells sharing HLA-Class 1 product. EBV-genome positive Daudi and Raji cells which lack HLA-Class 1 antigen and have mismactched HLA-Class 1 antigen, respectively showed resistance to killing. EBV-genome negative tumor cells except NK sensitive K562 cells were not killed by IM lymphocytes. However, the IM lymphocytes without atypical form in convalescent phase failed to show killing activity against autologous and allogeneic LCL. These findings suggest that cell surface membrane antigen structure on EBV-infected LCL may be able to explain the recognition and triggering of lysis of target cells by HLA-Class 1 restricted cytotoxic T cells (CTL) from acute IM. Phenotypic analysis of PBL with atypical form from IM was made by two-color flow cytometry. The data demonstrate that CD8+ T cells quantitatively represent the major population of lymphocytes expanded during acute IM. Furthermore, approximately 70% of these CD8+ T cells express HLA-DR on these surface, suggesting that they have undergone activation. However, IL 2R (CD25 antigen) expression was not significantly elevated on activated T cells. The salient profile on cytofluorographs of an acute IM was the increased number of CD3+CD19-, CD8+CD11b-, CD8+CD28+ and CD8+S6F1+ cells. However, CD3-CD19+, CD8+CD11b+, CD8+S6F1-, CD4+Leu8- and CD25+HLA-DR+ antigens were little expressed. Increased number of CD8+CD11b-, CD8+CD28+ and CD8+S6F1+ cells, which are regarded as CTL were reduced according to the improvement of the clinical symptoms and laboratory findings. These results together with HLA typing analysis suggested a possibility HLA-Class 1 restriction of the CTL with surface phenotype of CD8+CD11b-, CD8+CD28+, and CD8+S6F1+.     

Single-beat determination of Doppler-derived aortic flow measurement in patients with atrial fibrillation.

The clinical assessment of left ventricular systolic function in patients with atrial fibrillation is unreliable and difficult because of beat-to-beat variation. We initially evaluated an index that is on the basis of the ratio of preceding R-R (RR1) to pre-preceding R-R (RR2) intervals (RR1/RR2) for the measurement of Doppler aortic flow (peak flow velocity [Vp] and time-velocity integral [TVI] proportional to stroke volume) in 20 patients (aged 65 +/- 9.6 years) with atrial fibrillation. We obtained each parameter for >13 cardiac cycles, and the relationship between each parameter at a given cardiac beat and the RR1/RR2 ratio were evaluated by linear regression analysis. The value of each parameter at RR1/RR2 = 1 was calculated from the equation of linear regression line and compared with measured average value over all cardiac cycles. Both parameters showed a significant positive correlation with the RR1/RR2 ratio (Vp, r = 0.98, y = 1.01x + 0.61; TVI, r = 0.99, y = 1.01x + 0.26). The calculated value of each parameter at RR1/RR2 = 1 was quite similar to the average value (Vp, 97.4 +/- 30.8 vs 95.7 +/- 29.8 cm/s; TVI, 17.7 +/- 6.8 vs 17.3 +/- 6.7 cm, respectively). In the additional 20 patients (aged 77.4 +/- 15.2 years), Doppler aortic flow parameters of a single beat with identical RR1 and RR2 intervals were compared with measured average value over all cardiac cycles and showed similar results (Vp, r = 0.99, y = 0.99x + 3.4, P <.0001, bias -0.5 cm/s; TVI, r = 0.99, y = 0.92x + 1.5, P <.0001, bias 0.1 cm). In conclusion, the Doppler aortic flow at RR1/RR2 = 1 allows the left ventricular systolic parameters to be accurately evaluated during atrial fibrillation and obviates the less reliable process of averaging multiple irregular beats.     

Reversible inhibitor of MAO-A(RIMA)

Monoamine oxidase(MAO) inhibitors had been used in the treatment of depression since 1950s, but there is no MAO inhibitor available clinically in Japan. Liver dysfunction and tyramine's effect are main problems with MAO inhibitors. Reversible inhibitors of MAO-A(RIMA), new and improved MAO inhibitors, were developed and are widely used in Europe. RIMA causes less tyramine's effect and less liver dysfunction than classical MAO inhibitors do. Moclobemide, a RIMA, is under development in Japan(Phase II). An introduction of RIMA in Japan will be useful for the treatment of refractory depression and other anxiety disorders. We discussed pharmacological properties, clinical efficacy and safety of RIMA.     

Short‐ and long‐term outcomes following redo valvular surgery

Aim

We reviewed our experience in redo valvular surgery to evaluate trends in short‐ and long‐term outcomes.

Methods

We reviewed 414 patients (mean age, 62.8 ± 13.6 years) who underwent redo valvular surgery in the past 25 years. A total of 301 patients (54.2%) underwent first‐time redo valvular surgeries; 178 (32.1%) were second redos, 60 (10.8%) were third redos, and 16 were fourth redos (2.9%). The mean follow‐up period was 6.8 ± 6.3 years.

Results

Hospital mortality was 5.8%. New York Heart Association (NYHA) class III/IV (P = 0.0007, odds ratio = 4.403) and hemodialysis (P = 0.0383, odds ratio = 7.196) were risk factors for hospital death. Long‐term survival rates at 15 and 20 years were 64.7% ± 4.3% and 59.1% ± 5.0%, respectively. Predictors of late death were first time redo (P = 0.0076, hazard ratio = 0.422) and age younger than 61 years (P = 0.0005, hazard ratio = 0.229). There were significant differences in long‐term survival between NYHA classes I/II and III/IV (log‐rank test, P = 0.0419) and between the time from redo surgery (log‐rank test, P = 0.0189) and age (log‐rank test, P = 0.0001).

Conclusions

The hospital mortality rate for redo valve surgery has improved. Early referral for redo surgery can contribute to improving early and late outcomes.     

Early response assessment of palliative conventional radiotherapy for painful uncomplicated vertebral bone metastases

Background

Radiation therapy (RT) is the common treatment for painful vertebral bone metastases without paralysis by malignant spinal cord compression. However, no studies have focused on the time course of pain after RT. Then, we investigated the change of pain after RT for painful vertebral bone metastases without paralysis.