Predictors of Poststroke Aphasia Recovery A Systematic Review-Informed Individual Participant Data Meta-Analysis

Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. / Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. / Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. / Conclusions: Earlier intervention for poststroke aphasia was crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke

Comment letters to the National Commission on Commission on Fraudulent Financial Reporting, 1987 (Treadway Commission) Vol. 2

https://egrove.olemiss.edu/aicpa_sop/1662/thumbnail.jp

Predictors of Poststroke Aphasia Recovery

Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. Conclusions: Earlier intervention for poststroke aphasia as crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke

精索平滑筋肉腫の1例

61歳男.1年半前より左陰嚢内に腫瘤を自覚, 次第に増大してきた.触診上, 腫瘤は精巣と離れており, 精索に付着していた.弾性硬であること, 超音波検査上内部エコーが不均一なことより悪性が疑われ, 高位精巣切除を施行した.病理組織学的検査の結果, 精索原発の平滑筋肉腫であった.画像的に遠隔移転は認めなかった.術後に放射線療法を行った.術後32ヵ月を経過した現在, 再発は認めていないA 61-year-old man presented to our hospital with a 1.5-year history of a gradually enlarging mass in the left scrotum. The mass was apart from the testis and fixed to the spermatic cord. The firm consistency and heterogeneous expression on ultrasonography suggested a malignant tumor. Orchiectomy with high ligation of the spermatic cord was performed and a histological examination revealed leiomyosarcoma of the spermatic cord. Distant metastases were not observed. Because the incidence of local recurrence has been reported to be high, we performed irradiation to control the disease. At 32 months post-surgery he was alive with no evidence of disease

Vertical circulation due to deep-water renewal and phytoplankton blooms in the tropical fjord of Ambon Bay, eastern Indonesia

This study provides the first observational evidence on the role of deep-water renewal in triggering phytoplankton blooms in a rare shallow-silled tropical fjord (Ambon Bay). Seasonal variation in the tidal-induced deep-water intrusions into inner Ambon Bay (IAB, the fjord basin) upwardly displaces water from the IAB deep layer towards the surface. The budget method was employed to quantify vertical mixing in the deep layer of IAB (below sill depth) post-intrusions (stagnant periods). Within a spring-neap sequence (~ 2 weeks), deep-water intrusion pulses in IAB were observed to be more frequent in the easterly monsoon (July, eight pulses) than the transitional season (October, three pulses). These intrusion pulses uplifted the resident deep waters of IAB with rates of 2.4 - 4.0 m/day in the easterly monsoon and 1.5 - 1.8 m/day in the transitional season. Depth-averaged vertical diffusion coefficient (Kv) in the deep layer of IAB slightly varied between easterly monsoon (3.3 × 10-4 m2/s) and transitional season (3.7 × 10-4 m2/s). The parameterization of the vertical mixing-stratification relationship (Kv ∝ [N2]-β) in the IAB deep layer was found to be larger in easterly monsoon (β = 1.104) than in transitional season (β = 0.694). Chlorophyll-a concentration in the water column of IAB increased during uplifting events with phytoplankton bloom conditions (> 5 mg/m3) found only in the easterly monsoon. The described uplift mechanism as a driver of phytoplankton blooms should be included in future analyses of water quality for IAB

Frontogenesis and estuarine circulation at the shallow sill of a tropical fjord: Insights from Ambon Bay, eastern Indonesia

Surface water flushing of the tropical fjord of Ambon Bay is linked to stratification and frontogenesis that vary with tidal and seasonal cycles. Tidal-and seasonal-based deployments of CTD casts and bottom-mounted current meters in 2019 coupled with an analytical model were employed to investigate estuarine circulation (i.e. flood/ebb-mean transport) at the sill of Ambon Bay. Spring tides produce a large (flood/ebb-mean) horizontal salinity gradient, 8S/8x, (up to 13 x 10-4 parts per thousand/m) across the sill, intensifying estuarine circulation. This intensification of 8S/8x is driven by strong (flood/ebb-mean) stratification at the inshore sill, associated with buoyant frontogenesis (indicated by densimetric Froude number, Fo2 >= 0.3) during the related strong flood tides. Estuarine circulation is stronger in the easterly monsoon (July) than in the transitional monsoon (October) since buoyant fronts are larger in thickness and horizontal extension along the sill in the easterly monsoon following high freshwater input. The estuarine circulation was intensified by a deep-water renewal process in which deep water from the adjacent open sea is upwelled to the sill by internal waves.Flushing of inner Ambon Bay (IAB, the fjord basin) due to estuarine circulation at the sill only occurs at the surface layer of IAB. Within a spring-neap sequence (similar to 2 weeks), the net oceanic inflow due to estuarine circulation at the sill replenished 73% and 41% volume of the surface layer of IAB in the easterly monsoon and the transitional season, respectively. The knowledge of flushing of IAB due to net oceanic inflow presented here has application for the mitigation of pollution build-up and for understanding of oceanic nutrient supply in the basin

Internal tidal waves and deep-water renewal in a tropical fjord: lessons from Ambon Bay, eastern Indonesia

Seasonal-varying internal tidal dynamics have a critical role in deep-water renewal in tropical shallow-silled fjords (e.g. Ambon Bay, Indonesia). Seasonal- and tidal-based longitudinal CTD casts from the slope of outer Ambon Bay (OAB) to the sill of Ambon Bay coupled with bottom-mounted current meters at the sill and in inner Ambon Bay (IAB, the fjord basin), were employed to investigate the internal tidal-sill slope interaction and the characteristics of deep-water inflow. Weaker stratification in the easterly monsoonal season than the transitional monsoonal season (dT/dz = ~0.02 °C/m cf. dT/dz = ~0.06 °C/m) drives the predominant sub-critical slope condition at the OAB slope causing more frequent tidal upwelling events in the easterly monsoonal season (13 events in a spring-neap sequence) than in the transitional monsoonal season (5 events). The magnitude of tidal upwelling in Ambon Bay, as measured by the depth from which water upwells, is stronger in the easterly monsoonal season (up to 200 m) than in the transitional monsoonal season (maximum: 115 m). The influx of upwelled water across the sill was controlled by the tidal excursion of the deep-water plume in the easterly monsoonal season and by the deep-water/sill density difference in the transitional monsoonal season. A series of deep-water renewal events in IAB within a spring-neap sequence (~2 weeks) in the easterly monsoonal season supplied a total inflow volume of 0.09 ± 0.02 km3 which can replenish approximately 80% volume of the IAB deep layer. This total inflow volume was smaller in the transitional monsoonal season (0.05 ± 0.01 km3), hence, only flushing 40% volume of the IAB deep layer. The knowledge of internal tidal waves and deep-water inflow in Ambon Bay presented here will be a key reference for future studies focused on water transport in Ambon Bay and other shallow-silled tropical fjords