Protocol for the development of the international population registry for aphasia after stroke (I-PRAISE)

Background: We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia. Aim: To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia. Methods & Procedures: Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months. Conclusion: International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia

Stress Effect of Screw Insertion Angle for Base Plate Fixation on Humeral Spacer in Reverse Shoulder Arthroplasty

WOS: 000458828200002There have been numerous methods used for improving glenoid base plate stability in reverse shoulder arthroplasty. In this regard, screw insertion angle is the most significant parameter. Our claim is that screw insertion angle provokes changes in contact stress distribution on humeral spacer. We analyzed effect of 20 different models on humeral spacer with finite element analysis. This was comprised of 5 different screw angles, 4 different abduction positions of shoulder and five intact muscles (deltoid, teres major, infraspinatus, teres minor, subscapularis). The screw insertion angle affected stress distribution of humeral spacer and became more significant as the shoulder abduction reached 90 degrees where the maximum moment to the shoulder arm was applied. In addition, it is shown that screw insertion angle is not only an important parameter for the stress distribution but also the magnitude of the contact stress on humeral spacer due to the changes of direction of the transmitted load during the abduction. Contact stresses on quadrants of the humeral spacer could be influenced by changing screw insertion angle and shoulder abduction angle. Also, a screw insertion angle placement at 17 degrees provided the optimal stress distribution on the humeral spacer at all abduction positions of shoulder

A comparison of isokinetic muscle strength in patients with chondromalacia patella: A cross-sectional study

– OBJECTIVE: Chondromalacia patella (CMP), which is one of the most common causes of anterior knee pain in young adults, is often accompanied by reflex inhibition of the quadriceps muscle. In this respect, a significant correlation between isokinetic parameters and knee muscle strengths would be expected. We hypothesized that an isokinetic dynamometer, which objectively evaluates muscle strength, may be an important guide in detecting muscle weakness in new-onset CMP and determining early treatment strategies. PATIENTS AND METHODS: A total of 113 participants (mean age 30.33 ± 6.96 years, min: 18, max: 44) were recruited and divided into two groups, thus a CMP group (n=48) and a control group (n=65). The symptom duration of the CMP group and the demographic characteristics of all participants were recorded. Knee flexion and extension muscle strengths were measured at angular velocities of 60°/s and 180°/s [Knee extension Peak Torque at 60°/s (PTE60), Knee flexion Peak Torque at 60°/s (PTF60), Knee extension Peak Torque at 180°/s (PTE180), Knee flexion Peak at 180°/s (PTF180) respectively] (five sets) using an isokinetic dynamometer. We also recorded the total work done in flexion and extension (TWDF and TWDE). A modified MRI staging system based on the Outerbridge arthroscopy system was used to stage CMP. Isokinetic dynamometric parameters were compared between CMP patients and healthy volunteers. RESULTS: 59 healthy volunteers (90.8%) were right-side dominant and 6 (9.2%) left-side dominant. 33 CMP patients (68.8%) were right-side dominant, and 15 (31.3%) left-side dominant. 20 (41.7%) CMP patients were classified as Stage 1, 20 (41.7%) as Stage 2, and 8 (16.7%) as Stage 3. All the PTF60, PTE60, PTF180, and PTE180 values were significantly lower in the CMP group than in healthy controls (all p < 0.05). CMP symptom duration ≥ 6 months was associated with significantly lower knee muscle strength than with symptom duration < 6 months (p < 0.05). Also, a statistically negative correlation was found between MRI stages and PTE60 values (p < 0.05). CONCLUSIONS: In conclusion, our findings show that the isokinetic dynamometer reveals muscle weakness in CMP patients, and weakness in isokinetic parameters was negatively correlated with symptom duration and MRI stages. Isokinetic knee muscle strength testing, together with other functional tools, enables the assessment of muscle weakness and early rehabilitation planning for patients with CMP

Stabilization of chevron osteotomy with a capsuloperiosteal flap: Results in 15 years of follow-up

WOS: 000460166700001PubMed ID: 30827181Purpose: Distal chevron osteotomy (DCO) is used more frequently than other methods for the correction of mild-to-moderate hallux valgus deformity because it is markedly more stable. Here, we evaluated the use of a capsuloperiosteal flap to stabilize DCO and presented our last longer follow-up. Methods: This study included a total of 57 patients (86 feet) made up of 50 women (79 feet) and 7 men (7 feet) with a mean age of 37.8 years who were diagnosed with hallux valgus and met the inclusion criteria. These patients received treatment using a capsuloperiosteal flap to stabilize DCO from 1994 to 2000. Clinical outcomes of the patients were assessed using the American Orthopaedic Foot and Ankle Society hallux scale. Results: The mean follow-up duration was 14.8 years. The score increased from a preoperative mean of 52 points to a mean of 90.5 points at last follow-up. The mean hallux valgus angle changed from 30.3 degrees preoperatively to 14.4 degrees postoperatively at the last follow-up. The first to second intermetatarsal angle changed from 13.6 degrees preoperatively to 10.5 degrees postoperatively. The correction in the range of motion proved to be consistent with only an average of 1 degrees correction loss and 5.5 degrees loss. Eighty-four feet (97.6%) were pain-free. Discomfort with shoe wear was absent in 82 feet (95.3%) postoperatively, and 23 of 24 (95.8%) patients were fascinated cosmetically. Conclusion: Correction of mild-to-moderate hallux valgus deformity with the use of capsuloperiosteal flap for stabilization of DCO provided findings comparable with the literature regarding clinical and radiological outcomes at long-term follow-up

The large ectodomains of CD45 and CD148 regulate their segregation from and inhibition of ligated T-cell receptor.

T-cell receptor (TCR) triggering results in a cascade of intracellular tyrosine phosphorylation events that ultimately leads to T-cell activation. It is dependent on changes in the relative activities of membrane-associated tyrosine kinases and phosphatases near the engaged TCR. CD45 and CD148 are transmembrane tyrosine phosphatases with large ectodomains that have activatory and inhibitory effects on TCR triggering. This study investigates whether and how the ectodomains of CD45 and CD148 modulate their inhibitory effect on TCR signaling. Expression in T cells of forms of these phosphatases with truncated ectodomains inhibited TCR triggering. In contrast, when these phosphatases were expressed with large ectodomains, they had no inhibitory effect. Imaging studies revealed that truncation of the ectodomains enhanced colocalization of these phosphatases with ligated TCR at the immunological synapse. Our results suggest that the large ectodomains of CD45 and CD148 modulate their inhibitory effect by enabling their passive, size-based segregation from ligated TCR, supporting the kinetic-segregation model of TCR triggering

Hyperthermia with Mild Electrical Stimulation Protects Pancreatic β-Cells From Cell Stresses and Apoptosis

Induction of heat shock protein (HSP) 72 improves metabolic profiles in diabetic model mice.However, its impact on pancreatic β-cells is not known. The present study investigated whetherHSP72 induction can reduce β-cell stress signaling and apoptosis, and preserve β-cell mass.MIN6 cells and db/db mice were sham-treated or treated with heat shock (HS) + mild electricalstimulation (MES) to induce HSP72. Several cellular markers, metabolic parameters and β-cellmass were evaluated.HS+MES treatment or HSP72 overexpression increased the HSP72 protein levels and decreasedTNF-β-induced JNK phosphorylation, ER stress and pro-apoptotic signal in MIN6 cells. In db/dbmice, HS+MES treatment for 12 weeks significantly improved the insulin sensitivity and glucosehomeostasis. Upon glucose challenge, a significant increase in insulin secretion was observed invivo. Compared with sham treatment, the HSP72, insulin, PDX-1, GLUT2 and IRS-2 levels wereupregulated in the pancreatic islets of HS+MES-treated mice, whereas JNK phosphorylation,nuclear translocation of FOXO1 and NF-βB p65 were reduced. Apoptotic signals, ER stress andoxidative stress markers were attenuated.Thus, HSP72 induction by HS+MES treatment protects β-cells from apoptosis by attenuatingJNK activation and cell stresses. HS+MES combination therapy may preserve pancreatic β-cellvolume to ameliorate glucose homeostasis in diabetes