Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators.

Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls.

Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition).

Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05).

Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.     

Origin and characteristics of glycogen cells in the developing murine placenta.

The junctional zone (Jz) of the mouse placenta consists of two main trophoblast populations, spongiotrophoblasts and glycogen cells (GCs), but the development and function of both cell types are unknown. We conducted a quantitative analysis of GC size, number, and invasion of cells into the decidua across gestation. Furthermore, we identified markers of GC function to investigate their possible roles in the placenta. While the spongiotrophoblast cell volume doubles, and cell number increases steadily from E12.5 to E16.5, there is a remarkable 80-fold increase in GC numbers. This finding is followed by a notable decrease by E18.5. Surprisingly, the accumulation of GCs in the decidua did not fully account for the decrease in GC number in the Jz, suggesting loss of GCs from the placenta. Glucagons were detected on GCs, suggesting a steady glucose release throughout gestation. Connexin31 staining was shown to be specific for GCs. GC migration and invasion may be facilitated by temporally regulated expression of matrix metalloproteinase 9 and the imprinted gene product, Decorin. Expression of the clearance receptor for type II insulin-like growth factor (IGF-II), IGF2R, in a short developmental window before E16.5 may be associated with regulating the growth effects of IGF-II from glycogen cells and/or labyrinthine trophoblast on the expansion of the Jz. Thus stereology and immunohistochemistry have provided useful insights into Jz development and function of the glycogen cells.     

Postoperative pulmonary toxicity associated with mitomycin-C therapy.

As more patients survive cancer, and as more sophisticated multidrug antineoplastic protocols are developed, the chances of an anesthesiologist's coming into contact with patients who have been treated with such protocols are increasing. The anesthesiologist who must administer anesthesia to a patient who has had chemotherapy must be cognizant of the particular antineoplastic agents that have the potential for producing occult pulmonary dysfunction. Anesthetic management of these cases must be carefully planned and titrated to prevent further lung injury.     

Temporal studies of the impact of the braer oilspill on inshore feral fish from Shetland,Scotland

Activities of the petroleum-inducible mixed function oxygenase CYP1A (EROD) were measured in livers of inshore demersal fish species at various sites around the coast of Shetland to determine the sub-lethal impact of oil spilled after the wreck of the tanker M.V. Braer in January 1993. Visible coastal pollution by the oil was only apparent for some two weeks after the incident and tissue PAH levels in muscle of gadoid fish such as rockling from these areas were not elevated 3 months afterwards, while hepatic EROD activities were elevated some 7-to 9-fold. A 6.5-fold elevation was still observed 5 months afterwards; however, the levels had returned to those of fish from non-polluted environments 7 months after the incident and remained at baseline levels after the following winter's storm action. These data demonstrate the usefulness of enzymatic analysis as a sensitive method for assessing the temporal and spatial impact of an oil spill.     

Fatal occupational injuries in the United States, 1980 through 1985

The National Traumatic Occupational Fatality surveillance project was designed to gather demographic, employment, and injury information from death certificates for all deaths due to injuries at work in the United States. Approximately 7000 workers have died each year during the 6-year period from 1980 through 1985: 94% were men, and 6% were women. Unintentional injuries caused the deaths of 83% of the men and 50% of the women. Eleven percent of the men and 39% of the women died from homicide. While the greatest number of deaths occurred in the group aged 20 through 34 years, fatality rates were highest among those aged 70 years and older. Expressed as deaths per 100,000 workers, annual fatality rates for black workers (7.7) were slightly higher than for white workers (6.5). The four industrial groups with the highest fatality rates were mining (31.9); transportation, communication, and public utilities (25.4); construction (24.0); and agriculture, forestry, and fishing (20.7). From 1980 through 1985 the annual traumatic occupational fatality rate fell 23%.     

Registration of myocardial infarction and stroke in the Kilkenny Health Project: Methodology

A myocardial infarction and stroke register was established in January 1987 as part of the evaluation of the Kilkenny Health Project This is a community programme which aims to reduce risk factors for coronary heart disease. The register records acute myocardial infarction and stroke in residents of County Kilkenny and of the reference county. This will provide accurate estimates of the incidence of these diseases and of trends over time. Methods used comply with the protocol in use by the WHO MONICA Project. This will allow comparison of the incidence of coronary heart disease and stroke in this register with that in other MONICA locations, including that in Belfast, Northern Ireland.