Robot therapy for functional recovery of the upper limbs: a pilot study on patients after stroke.

Objective: To verify the possibility of administering robotaided therapy for the upper limbs in patients after stroke; to evaluate patients' degree of acceptance and compliance with the treatment; to establish if the treatment has an effect on motor impairment and functional outcome. Design: Quasi-experimental, uncontrolled study. Subjects: Fourteen patients with chronic hemiparesis after stroke. Methods: Patients were treated with a robotic system for the upper limbs (ReoGo TM ; Motorika Medical Ltd, Israel). Subjects performed the following assessment, at the start (T0), at the end of treatment (T1), and at the follow-up performed one month after the end of treatment (T2): Fugl-Meyer test (FM) for upper limbs; strength evaluation; Ashworth scale; visual analogue scale (VAS) for pain; Frenchay Arm test (FAT); Box and Block test (BB Functional Independence Measure (FIM TM ); ABILHAND Questionnaire; Timed Up and Go test (TUG); Euro-Quality of Life questionnaire and; a VAS for treatment satisfaction were administered to the subjects. Results: Total scores of FM, B&B, FAT and FIM TM showed a statistically significant improvement from T0 and T1 (FM p < 0.002, B&B p < 0.012, FAT p < 0.023, FIM TM p < 0.007) and from T0 and T2 (FM p < 0.003, B&B p < 0.011, FAT p < 0.024, FIM p < 0.027). No statistically significant differences were found between evaluations at T1 and T2 (FM p < 0.595, B&B p < 0.491, FAT p < 0.317, FIM p < 0.180). Conclusion: The sample was capable of completing the treatment and demonstrated good participant satisfaction. This pilot study led to the finding of a clinical improvement and excellent patient compliance. It can be hypothesized that the results are robot-dependent and that they were learned and then maintained. However, the study is limited in that a control group was not used. As such, it is desirable to continue this study with a control group, as well as by designing a prospective longitudinal randomized controlled trial study

Digital accessible knowledge: Mobilizing legacy data and the future of taxonomic publishing

No abstract available

Oral liquid L-thyroxine (L-t4) may be better absorbed compared to L-T4 tablets following bariatric surgery.

Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation

Long-term neuropsychological sequelae, emotional wellbeing and quality of life in patients with acquired thrombotic thrombocytopenic purpura

Neurological symptoms related to microthrombosis are the hallmark of acute manifestations of acquired thrombotic thrombocytopenic purpura. Despite the achievement of hematological remission, patients may report persisting neurological impairment that affects their quality of life. To assess the long-term neuropsychological consequences of acute thrombotic thrombocytopenic purpura, we recruited 35 acquired thrombotic thrombocytopenic purpura patients (77% females, median age at onset 41 years, interquartile range 35-48) regularly followed at our out-patient clinic of thrombotic microangiopathies in Milan (Italy) from December 2015 to October 2016. Patients underwent a psychological evaluation of memory and attentional functions, emotional wellbeing and health-related quality of life at least 3 months after their last acute thrombotic thrombocytopenic purpura event (median 36 months, interquartile range 17-54). During the psychological consultation, 17 patients (49%) referred persisting subjective neurological impairment in the frame of a remission phase, with at least one symptom as disorientation, loss of concentration, dizziness, lack of balance, headache and diplopia. Neuropsychological assessment revealed lower scores than the Italian general population pertaining to direct, indirect and deferred memory. A higher degree of impairment of memory domains was found in patients with neurological involvement at the time of presentation of the first acute thrombotic thrombocytopenic purpura episode. Anxiety and depression were detected in 7 (20%) and 15 (43%) patients, respectively. Health-related quality of life was lower than the Italian general population, with mental domains more impacted than physical domains (mean difference 58.43, 95% confidence interval [-71.49, -45.37]). Our study demonstrates compromised memory and attention functions, persisting anxiety/depression symptoms and a generally reduced quality of life in patients surviving from acute acquired thrombotic thrombocytopenic purpura. New clinical strategies should be considered to improve these symptoms

Relationship between fatty liver and glucose metabolism: A cross-sectional study in 571 obese children

BACKGROUND AND AIMS: Early onset type 2 diabetes mellitus (T2DM) is associated with obesity, insulin resistance and impaired beta-cell function. Non-alcoholic fatty liver disease (NAFLD) may be an independent risk factor for T2DM. We investigated the relationship between NAFLD and glucose metabolism in a large sample of obese children. METHODS AND RESULTS: A total of 571 obese children (57% males and 43% females) aged 8-18 years were consecutively studied at a tertiary care centre specialised in paediatric obesity. Liver ultrasonography was used to diagnose NAFLD after exclusion of hepatitis B and C and alcohol consumption. Oral-glucose tolerance testing (OGTT) was performed; insulin sensitivity was evaluated by using the insulin sensitivity index (ISI) and beta-cell function by using the ratio between the incremental areas under the curve (AUC) of insulin and glucose (incAUCins/incAUCglu). A total of 41% of the obese children had NAFLD. Impaired glucose tolerance or T2DM was present in 25% of the children with NAFLD versus 8% of those without it (p<0.001). Children with NAFLD had higher body mass index (BMI), fasting glucose, 120-min OGTT glucose, incAUCins/incAUCglu and lower ISI as compared with children without NAFLD (p</=0.002). At bootstrapped multivariable median regression analysis controlling for gender, age, pubertal status and BMI, NAFLD was an independent predictor of 120-min OGTT glucose and ISI, but not of incAUCins/incAUCglu. Similar findings were obtained using continuous liver steatosis as the predictor, instead of dichotomous NAFLD. CONCLUSION: NAFLD was present in 41% of our obese children and was associated with higher insulin resistance, but not with impaired beta-cell function

Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis

Objective: To measure body water distribution and to evaluate the accuracy of eight-polar bioelectrical impedance analysis (BIA) for the assessment of total body water (TBW) and extracellular water (ECW) in severe obesity. Design: Cross-sectional study. Setting: Obesity clinic. Subjects: In all, 75 women aged 18-66 y, 25 with body mass index (BMI) between 19.1 and 29.9 kg/m(2) (ie not obese), 25 with BMI between 30.0 and 39.9 kg/m(2) (ie class I and II obese), and 25 with BMI between 40.0 and 48.2 kg/m(2) (ie class III obese). Methods: TBW and ECW were measured by (H2O)-H-2 and Br dilution. Body resistance (R) was obtained by summing the resistances of arms, trunk and legs as measured by eight-polar BIA (InBody 3.0, Biospace, Seoul, Korea). The resistance index at a frequency of x kHz (RIx) was calculated as height 2/R-x. Results: ECW: TBW was similar in women with class III (46 +/- 3%, mean +/- s.d.) and class I-II obesity (45 +/- 3%) but higher than in nonobese women (39 +/- 3%, P < 0.05). In a random subsample of 37 subjects, RI500 explained 82% of TBW variance (P < 0.0001) and cross-validation of the obtained algorithm in the remaining 38 subjects gave a percent root mean square error (RMSE%) of 5% and a pure error (PE) of 2.1 l. In the same subjects, RI5 explained 87% of ECW variance (P < 0.0001) and cross-validation of the obtained algorithm gave a RMSE% of 8% and a PE of 1.4 l. The contribution of weight and BMI to the prediction of TBW and ECW was nil or negligible on practical grounds. Conclusions: ECW: TBW is similar in women with class I-II and class III obesity up to BMI values of 48.2 kg/m(2). Eight-polar BIA offers accurate estimates of TBW and ECW in women with a wide range of BMI (19.1-48.2 kg/m(2)) without the need of population-specific formulae

Anti-atherogenic modification of serum lipoprotein function in patients with rheumatoid arthritis after tocilizumab treatment, a pilot study

Lipid metabolism derangement contributes to increased cardiovascular risk in Rheumatoid Arthritis (RA). It is still debated whether and how tocilizumab, an interleukin-6 receptor inhibitor used in active RA, impacts cardiovascular risk. We studied the effect of tocilizumab on the regulation of macrophage cholesterol homeostasis, measuring patient serum ability to respectively load (cholesterol loading capacity, CLC) and discharge (cholesterol efflux capacity, CEC) cells with cholesterol. Patients with RA (n = 8) were studied before and after 4 and 12 weeks of tocilizumab treatment. CLC was measured by a fluorimetric assay of intracellular cholesterol content in human macrophages and CEC was measured for the three main pathways, mediated by the transporters Scavenger Receptor class B-type I (SR-BI), ATP binding cassette-G1 (ABCG1) and-A1 (ABCA1) in specific cell models. After 12 weeks of tocilizumab treatment, serum LDL cholesterol levels were increased, while CLC was reduced. HDL cholesterol levels were unchanged, but CEC was significantly ameliorated for the SR-BI and ABCG1 pathways with respect to baseline. Tocilizumab reduces LDL pro-atherogenic potential despite increasing their serum levels and increases HDL protective activity in RA. The data of our pilot study suggest that tocilizumab regulates lipoprotein function in selected patient populations and lay the groundwork for future larger studies

Dynamic correlations of the Coulomb Luttinger liquid

The dynamic density response function, form-factor, and spectral function of a Luttinger liquid with Coulomb electron-electron interaction are studied with the emphasis on the short-range electron correlations. The Coulomb interaction changes dramatically the density response function as compared to the case of the short-ranged interaction. The form of the density response function is smoothing with time, and the oscillatory structure appears. However, the spectral functions remain qualitatively the same. The dynamic form-factor contains the $\delta$-peak in the long-wave region, corresponding to one-boson excitations. Besides, the multi-boson-excitations band exists in the wave-number region near to $2k_F$. The dynamic form-factor diverges at the edges of this band, while the dielectric function goes to zero there, which indicates the appearance of a soft mode. We develop a method to analyze the asymptotics of the spectral functions near to the edges of the multi-boson-excitations band.Comment: 11 pages, 3 figures, submitted to PR

External Validation Of Equations To Estimate Resting Energy Expenditure In 14952 Adults With Overweight And Obesity And 1948 Adults With Normal Weight From Italy

Background & aims: We cross-validated 28 equations to estimate resting energy expenditure (REE) in a very large sample of adults with overweight or obesity. Methods: 14952 Caucasian men and women with overweight or obesity and 1498 with normal weight were studied. REE was measured using indirect calorimetry and estimated using two meta-regression equations and 26 other equations. The correct classification fraction (CCF) was defined as the fraction of subjects whose estimated REE was within 10% of measured REE. Results: The highest CCF was 79%, 80%, 72%, 64%, and 63% in subjects with normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. The Henry weight and height and Mifflin equations performed equally well with CCFs of 77% vs. 77% for subjects with normal weight, 80% vs. 80% for those with overweight, 72% vs. 72% for those with class 1 obesity, 64% vs. 63% for those with class 2 obesity, and 61% vs. 60% for those with class 3 obesity. The Sabounchi meta-regression equations offered an improvement over the above equations only for class 3 obesity (63%). Conclusions: The accuracy of REE equations decreases with increasing values of body mass index. The Henry weight & height and Mifflin equations are similarly accurate and the Sabounchi equations offer an improvement only in subjects with class 3 obesity

Cranial ultrasound screening in term and late preterm neonates born by vacuum-assisted delivery: Is itworthwhile?

Background: Vacuum extraction is the most common choice to assist vaginal delivery, but there are still concerns regarding the neonatal injuries it may cause. This study aimed to evaluate the rate of intracranial injuries assessed by cranial ultrasound (cUS) among infants born by vacuum extraction, and the relationship with maternal and perinatal factors. Methods: This was a single-center retrospective study carried out in a level-3 neonatal unit. A total of 593 term and late preterm infants born by vacuum-assisted delivery were examined with a cUS scan within 3 days after birth. Results: Major head injuries were clinically silent and occurred in 2% of the infants, with a rate of intracranial haemorrhage of 1.7%. Regardless of obstetric factors, the risk of cranial injury was increased in infants requiring resuscitation at birth (p = 0.04, OR 4.1), admitted to NICU (p = 0.01, OR 5.5) or with perinatal asphyxia (p &lt; 0.01, OR 21.3). Maternal age ≥40 years correlated both with adverse perinatal outcomes (p &lt; 0.05) and the occurrence of major injury (p = 0.02, OR 4.6). Conclusion: Overall, vacuum extraction is a safe procedure for neonates. Head injuries are usually mild and asymptomatic, and with spontaneous recovery. However, the rate of major cranial injuries in our cohort warrants further investigation to support a cUS screening, particularly for infants requiring respiratory support at birth. Also, maternal age might be taken into account when evaluating the risk for neonatal complications after vacuum application