Interventions to Reduce Spasticity and Improve Function in People With Chronic Incomplete Spinal Cord Injury: Distinctions Revealed by Different Analytical Methods.

Background. Spinal cord injury (SCI) results in impaired function, and ankle joint spasticity is a common secondary complication. Different interventions have been trialed with variable results. Objective. We investigated the effects of pharmacological and physical (locomotor training) interventions on function in people living with incomplete motor function loss caused by SCI and used different analytical techniques to understand whether functional levels affect recovery with different interventions. Methods. Participants with an incomplete SCI were assigned to 3 groups: no intervention, Lokomat, or tizanidine. Outcome measures were the 10-m walk test, 6-minute walk test, and the Timed Up and Go. Participants were classified in 2 ways: (1) based on achieving an improvement above the minimally important difference (MID) and (2) using growth mixture modeling (GMM). Functional levels of participants who achieved the MID were compared and random coefficient regression (RCR) was used to assess recovery in GMM classes. Results. Overall, walking speed and endurance improved, with no difference between interventions. Only a small number of participants achieved the MID. Both MID and GMM-RCR analyses revealed that tizanidine improved endurance in high-functioning participants. GMM-RCR classification also showed that speed and mobility improved after locomotor training. Conclusions. Improvements in function were achieved in a limited number of people with SCI. Using the MID and GMM techniques, differences in responses to interventions between high-and low-functioning participants could be identified. These techniques may, therefore, have potential to be used for characterizing therapeutic effects resulting from different interventions

A strategy for stroke

Since the 1990s, Professor Martin M Brown of the University College London Institute of Neurology has been leading international, multicentre clinical trials to establish suitable treatments for reducing stroke risk in individuals with carotid artery stenosi

Management of carotid near-occlusion and acute carotid occlusion

As a stenosis becomes more severe, blood flow through it increases in velocity to maintain volume, flow and pressure. But there is a critical point beyond which further increase in stenosis no longer allows sufficient blood to pass through to maintain volumetric flow, and the carotid artery beyond the stenosis begins to decrease in diameter. This is the near occlusion. To maintain a sufficient blood flow in affected area, there is a progressive recruitment of collaterals followed by an activation of cerebral autoregulation with dilatation of resistance vessels. When this process fails to maintain normal cerebral blood flow, oxygen extraction fraction of the affected brain tissue increases to maintain normal cerebral metabolism. Near occlusion has been described as involving 1 to 10% of all severe stenosis, but the potential for stroke from such critical stenosis is less than its appearance would suggest. The optimum management of near-occlusion therefore remains a matter of debate. Although endarterectomy for carotid stenosis of 70-99% was associated with an absolute risk reduction in any stroke or death of 16% in the original randomized trials, the benefit was less in patients with near-occlusion. In 2015, a meta-analysis focused on patients with near-occlusion confirmed only a small benefit of carotid endarterectomy or stenting compared to medical treatment in patients with near occlusion. In patients with near-occlusion and compromised hemodynamics, revascularization should improve cerebral blood flow and consequently prevent ischemic stroke. Nevertheless the effect of improved cerebral hemodynamics after revascularization on prevention of ischemic stroke is uncertain

Effect of pulsed power on particle matter in diesel engine exhaust using a DBD plasma reactor

Nonthermal plasma (NTP) treatment of exhaust gas is a promising technology for both nitrogen oxides (NOX) and particulate matter (PM) reduction by introducing plasma into the exhaust gases. This paper considers the effect of NTP on PM mass reduction, PM size distribution, and PM removal efficiency. The experiments are performed on real exhaust gases from a diesel engine. The NTP is generated by applying high-voltage pulses using a pulsed power supply across a dielectric barrier discharge (DBD) reactor. The effects of the applied high-voltage pulses up to 19.44 kVpp with repetition rate of 10 kHz are investigated. In this paper, it is shown that the PM removal and PM size distribution need to be considered both together, as it is possible to achieve high PM removal efficiency with undesirable increase in the number of small particles. Regarding these two important factors, in this paper, 17 kVpp voltage level is determined to be an optimum point for the given configuration. Moreover, particles deposition on the surface of the DBD reactor is found to be a significant phenomenon, which should be considered in all plasma PM removal tests

Feasibility of collecting oral fluid samples in the home setting to determine seroprevalence of infections in a large-scale cohort of preschool-aged children

Oral fluid is a non-invasive biological sample, which can be returned by post, making it suitable for large-scale epidemiological studies in children. We report our experience of oral fluid collection from 14 373 preschool-aged children in the UK Millennium Cohort Study. Samples were collected by mothers in the home setting following the guidance of trained interviewers, and posted to the laboratory. Samples were received from 11698 children (81.4 %). Children whose mothers were of Black Caribbean ethnicity and who lived in non-English-speaking households were less likely to provide a sample, and those with a maternal history of asthma more likely to provide a sample [adjusted risk ratio (95 % CI) 0.85 (0.73-0.98), 0.87 (0.77-0.98) and 1.03 (1.00-1.05) respectively]. Collection of oral fluid samples is feasible and acceptable in large-scale child cohort studies. Formal interpreter support may be required to increase participation rates in surveys that collect biological samples from ethnic minorities

Cytomegalovirus pneumonitis complicated by a central peribronchial pattern of organising pneumonia

We present five cases of cytomegalovirus (CMV) pneumonitis occurring in patients after recent T cell deplete allogeneic stem cell transplantation (AlloHSCT). These cases were complicated by an organising pneumonia (during the recovery period) with a predominantly central peribronchial pattern. All patients presented with evidence of active CMV pneumonitis which was treated successfully with anti-viral therapy but was followed by persistent severe dyspnoea, cough and hypoxia. High resolution computed tomography (HRCT) imaging showed widespread central peribronchial consolidation with traction bronchiectasis. There was a marked clinical and physiological improvement after treatment with systemic corticosteroids. However, in all patients the lung function remained abnormal and in some cases imaging revealed a fibrosing lung disease. These cases represent a previously undescribed central peribronchial pattern of organising pneumonia complicating CMV pneumonitis that can result in chronic lung damage

The legacy of translocations among populations of the Ibizan Wall Lizard, Podarcis pityusensis (Squamata: Lacertidae)

The Ibizan wall lizard, Podarcis pityusensis, was the subject of several documented 25 translocations by the German herpetologist Martin Eisentraut, in 1930. He aimed to initiate 26 long-term experiments into the evolution of melanism and other morphological traits and 27 accordingly reported introductions into five islets that (he believed) contained no lizards. In 28 this study, we analysed the genetics and morphological characteristics of individuals we found 29 there. We found no lizards on two of the islets, namely Escull de Tramuntana or Galera, but 30 for the first time, detected a large population on a third, Es Vaixell. Analyses of microsatellite 31 DNA placed individuals from a fourth islet, Dau Gran, with those from the islet of Escull 32 Vermell. They are also morphologically close to individuals from Escull Vermell. This 33 suggests that selection pressures could have favoured the Escull Vermell phenotype following 34 introduction. Eisentraut founded the Es Vaixell population with non- melanic Ibizan 35 specimens, but the present day population of Es Vaixell was found to be fully melanic. Genetic 36 markers support a strong similarity between Es Vaixell and Na Gorra, and indicate that, in all 37 likelihood, the individuals introduced by Eisentraut have left no descendants. It is likely that 38 Es Vaixell already contained lizards prior to this introduction. For reasons which we discuss, 39 the translocations have revealed less than Eisentraut would have originally hoped for, although 40 they do provide some potential insights into lizard morphological evolution following 41 colonization

Management of atherosclerotic extracranial carotid artery stenosis

Atherosclerosis leading to stenosis of the internal carotid artery is the underlying cause of 8–15% of ischaemic strokes (symptomatic carotid stenosis). 1–2% of the adult population have asymptomatic carotid stenosis. Clinical trials in patients with symptomatic carotid stenosis showed a higher procedural risk of non-disabling stroke with stenting versus endarterectomy, but a higher risk of myocardial infarction, cranial nerve palsy, and access site haematoma with endarterectomy. Apart from procedural complications, both treatments are equally effective in preventing stroke and recurrent severe carotid stenosis in the medium-to-long term. Endarterectomy has a modest effect in preventing stroke among patients with asymptomatic carotid stenosis, whereas the role of stenting remains to be established. With advances in medical therapy against atherosclerosis, benefit from invasive therapy has become uncertain. Risk modelling, with the inclusion of brain and carotid plaque imaging, will become increasingly important in selecting patients for interventions

von Willebrand factor/ADAMTS13 ratio at presentation of acute ischemic brain injury is predictive of outcome

Acute ischemic stroke (IS) and transient ischemic attack (TIA) are associated with raised von Willebrand factor (VWF) and decreased ADAMTS13 activity (ADAMTS13Ac). Their impact on mortality and morbidity is unclear. We conducted a prospective investigation of the VWF-ADAMTS13 axis in 292 adults (acute IS, n = 103; TIA, n = 80; controls, n = 109) serially from presentation until >6 weeks. The National Institutes of Health Stroke Score (NIHSS) and modified Rankin scale (mRS) were used to assess stroke severity. Presenting median VWF antigen (VWF:Ag)/ADAMTS13Ac ratios were: IS, 2.42 (range, 0.78-9.53); TIA, 1.89 (range, 0.41-8.14); and controls, 1.69 (range, 0.25-15.63). Longitudinally, the median VWF:Ag/ADAMTS13Ac ratio decreased (IS, 2.42 to 1.66; P = .0008; TIA, 1.89 to 0.65; P 2.6 predicted mortality (odds ratio, 6.33; range, 2.22-18.1). Those with a VWF:Ag/ADAMTS13Ac ratio in the highest quartile (>3.091) had 31% increased risk mortality. VWF:Ag/ADAMTS13Ac ratio at presentation of ischemic brain injury was associated with higher mRS (P = .021) and NIHSS scores (P = .029) at follow-up. Thrombolysis resulted in prompt reduction of the VWF:Ag/ADAMTS13Ac ratio and significant improvement in mRS on follow-up. A raised VWF:Ag/ADAMTS13Ac ratio at presentation of acute IS or TIA is associated with increased mortality and poorer functional outcome. A ratio of 2.6 seems to differentiate outcome. Prompt reduction in the ratio in thrombolysed patients was associated with decreased mortality and morbidity. The VWF:Ag/ADAMTS13Ac ratio is a biomarker for the acute impact of an ischemic event and longer-term outcome