Does assisted cycling improve function in those with Parkinson’s disease?

Background: Functional decline is a cardinal sign of Parkinson’s disease (PD), a neurodegenerative disease that affects 1% of individuals over the age of 60. Physical symptoms have a detrimental effect on activities of daily living and quality of life. High intensity exercise has enhanced neuroplasticity and reduced the rate of dopaminergic cell loss in animal studies. One form of high intensity exercise is assisted cycling, which has been shown to be effective for those with other neurological disorders. There is no consensus as to the efficacy in those with PD. Objective: To explore the efficacy of assisted cycling in improving motor function in people with PD. Method: A systematic search of PsycINFO, ScienceDirect, SPORTDiscus, CINAHL, arXiv, MEDLINE and Web of Science was conducted, including articles from January 2003 to October 2016. Studies were assessed for quality using a critical appraisal tool. No articles were excluded due to quality. Results: Seven studies were included in this review, with a total sample of 179 participants with a diagnosis of PD. Four studies were randomised control trials, the others included two case control trials, and a single-subject design trial. The level of cycle assistance, length of intervention and sessions varied between studies. All interventions showed improvements in motor function, with a greater effect on those with more advanced PD. Conclusion: There is moderate evidence to show the efficacy of assisted cycling in improving global motor function in individuals with PD. Future research is required to determine optimum assisted cycling interventions in terms of frequency, duration of sessions and length. The long-term effects of assisted cycling should also be explored in future research

Transverse measures, the modular class and a cohomology pairing for Lie algebroids

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Clinicopathologic consensus study of gray zone lymphoma with features intermediate between DLBCL and classical HL

Gray zone lymphoma (GZL) is described as sharing features with classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL). However, there remains complexity in establishing diagnosis, delineating prognosis, and determining optimum therapy. Sixty-eight cases diagnosed as GZL across 15 North American academic centers were evaluated by central pathology review to achieve consensus. Of these, only 26 (38%) were confirmed as GZL. Morphology was critical to GZL consensus diagnosis (eg, tumor cell richness); immunohistochemistry showed universal B-cell derivation, frequent CD30 expression, and rare Epstein-Barr virus (EBV) positivity (CD20(+), 83%; PAX5(+), 100%; BCL6(+), 20%; MUM1(+), 100%; CD30(+), 92%; EBV(+), 4%). Forty-two cases were reclassified: nodular sclerosis (NS) cHL, n = 27 (including n = 10 NS grade 2); lymphocyte predominant HL, n = 4; DLBCL, n = 4; EBV(+) DLBCL, n = 3; primary mediastinal large BCL n = 2; lymphocyte-rich cHL and BCL-not otherwise specified, n = 1 each. GZL consensus-confirmed vs reclassified cases, respectively, more often had mediastinal disease (69% vs 41%; P = .038) and less likely more than 1 extranodal site (0% vs 25%; P = .019). With a 44-month median follow-up, 3-year progression-free survival (PFS) and overall survival for patients with confirmed GZL were 39% and 95%, respectively, vs 58% and 85%, respectively, for reclassified cases (P = .19 and P = .15, respectively). Interestingly, NS grade 2 reclassified patients had similar PFS as GZL consensus-confirmed cases. For prognostication of GZL cases, hypoalbuminemia was a negative factor (3-year PFS, 12% vs 64%; P = .01), whereas frontline cyclophosphamide, doxorubicin, vincristine, and prednisone +/- rituximab (CHOP+/-R) was associated with improved 3-year PFS (70% vs 20%; P = .03); both factors remained significant on multivariate analysis. Altogether, accurate diagnosis of GZL remains challenging, and improved therapeutic strategies are needed

An Analysis of How Students Take the Initiative in Keyboard-to-Keyboard Tutorial Dialogues in a Fixed Domain

By student initiatives we mean productions which the student could reasonably expect to modify the course of the tutorial dialog;ue. Asking a question is one kind of student initiative. This paper describes a system called CircSim-Tutor which we are building, the background of the project, the 28 hour-long tutoring sessions jmalyzed in this paper, and the analysis done. It compares our work to previous work, gives a classification of the student initiatives found and of the tutor's responses to them, and discusses some examples

Allogeneic hematopoietic cell transplantation as curative therapy for patients with non-Hodgkin lymphoma: Increasingly successful application to older patients

AbstractNon-Hodgkin lymphoma (NHL) constitutes a collection of lymphoproliferative disorders with widely varying biological, histological, and clinical features. For the B cell NHLs, great progress has been made due to the addition of monoclonal antibodies and, more recently, other novel agents including B cell receptor signaling inhibitors, immunomodulatory agents, and proteasome inhibitors. Autologous hematopoietic cell transplantation (auto-HCT) offers the promise of cure or prolonged remission in some NHL patients. For some patients, however, auto-HCT may never be a viable option, whereas in others, the disease may progress despite auto-HCT. In those settings, allogeneic HCT (allo-HCT) offers the potential for cure. Over the past 10 to 15 years, considerable progress has been made in the implementation of allo-HCT, such that this approach now is a highly effective therapy for patients up to (and even beyond) age 75 years. Recent advances in conventional lymphoma therapy, peritransplantation supportive care, patient selection, and donor selection (including the use of alternative hematopoietic cell donors), has allowed broader application of allo-HCT to patients with NHL. As a result, an ever-increasing number of NHL patients over age 60 to 65 years stand to benefit from allo-HCT. In this review, we present data in support of the use of allo-HCT for patients with diffuse large B cell lymphoma, follicular lymphoma, and mantle cell lymphoma. These histologies account for a large majority of allo-HCTs performed for patients over age 60 in the United States. Where possible, we highlight available data in older patients. This body of literature strongly supports the concept that allo-HCT should be offered to fit patients well beyond age 65 and, accordingly, that this treatment should be covered by their insurance carriers

Weak splittings of quotients of Drinfeld and Heisenberg doubles

We investigate the fine structure of the simplectic foliations of Poisson homogeneous spaces. Two general results are proved for weak splittings of surjective Poisson submersions from Heisenberg and Drinfeld doubles. The implications of these results are that the torus orbits of symplectic leaves of the quotients can be explicitly realized as Poisson-Dirac submanifolds of the torus orbits of the doubles. The results have a wide range of applications to many families of real and complex Poisson structures on flag varieties. Their torus orbits of leaves recover important families of varieties such as the open Richardson varieties.Comment: 20 pages, AMS Late

Nonlocal regularization of abelian models with spontaneous symmetry breaking

We demonstrate how nonlocal regularization is applied to gauge invariant models with spontaneous symmetry breaking. Motivated by the ability to find a nonlocal BRST invariance that leads to the decoupling of longitudinal gauge bosons from physical amplitudes, we show that the original formulation of the method leads to a nontrivial relationship between the nonlocal form factors that can appear in the model.Comment: 11 pages, uses amsart. To appear in Mod. Phys. Lett

Modular classes of Poisson-Nijenhuis Lie algebroids

The modular vector field of a Poisson-Nijenhuis Lie algebroid $A$ is defined and we prove that, in case of non-degeneracy, this vector field defines a hierarchy of bi-Hamiltonian $A$-vector fields. This hierarchy covers an integrable hierarchy on the base manifold, which may not have a Poisson-Nijenhuis structure.Comment: To appear in Letters in Mathematical Physic

PD-L1 expression in EBV-negative diffuse large B-cell lymphoma: clinicopathologic features and prognostic implications

Programmed cell death ligand 1 (PD-L1) is a cell surface glycoprotein that regulates the cellular immune response and serves as a targetable immune checkpoint molecule. PD-L1 is expressed on tumor cells and the immune microenvironment of several human malignancies, including a subset of aggressive lymphomas. We sought to investigate further the clinical and pathologic features of EBV-negative diffuse large B-cell lymphoma (DLBCL) cases that express PD-L1. Immunohistochemical staining using an anti-PD-L1 monoclonal antibody was performed on DLBCL cases from 86 patients. These patients received standard chemotherapy treatment and were followed for up to 175 months. Overall, 14 cases (16%) were considered positive for PD-L1 in tumor cells. In comparison with PD-L1 negative cases, PD-L1 positive cases had a higher rate of non-GCB type (71% vs. 30%, P=0.0060), and higher Ann Arbor stage (II-IV) (100% vs. 73%, P=0.0327). No significant differences were seen in the immunohistochemical expression of BCL2, MYC, or Ki67. Patients with tumors expressing PD-L1 demonstrated inferior overall survival (OS) upon long term follow up (P=0.0447). Both age/sex-adjusted and multivariate analyses identified PD-L1 as an independent predictor for OS (P=0.0101 and P=0.0424). There was no significant difference, however, in terms of remission rates after first treatment, relapse rates, and progression free survival between the groups. Identification of DLBCL cases that express PD-L1 may serve to select a subset of patients that could further benefit from targeted immunotherapy