The cognitive and behavioural profile of Amyotrophic Lateral Sclerosis: Application of the consensus criteria

Abstract. OBJECTIVE: The study aims to assess the spectrum of cognitive and behavioural disorders in patients affected by Amyotrophic Lateral Sclerosis (ALS) according to the recent consensus criteri

O EFEITO DA REALIDADE VIRTUAL NA CAPACIDADE FUNCIONAL DE MEMBROS SUPERIORES EM INDIVÍDUOS COM HEMIPARESIA

Stroke may lead to total and/or partial loss of normal function in one of the upper limbs, and the rehabilitation is one of the main focuses of physiotherapists. The objective was to analyze the effects of virtual reality on upper limb functional capacity in individuals with hemiparesis. Initially they were evaluated for manual dexterity by the Nine Hole Peg Test (NHPT) and Box and Blocks Test (BBT) then be conducted to perform a 16-session protocol using virtual reality game through Nintendo WiiTM console. ™. We included 10 individuals with mean age of 64.5±9.54 and did not demonstrated significant results when comparing the moments, only a small effect (d=0.23) was found in the left upper limb in the NHPT. It was concluded, there was no significant improvement in the functional capacity of the upper limbs using virtual reality in individuals with hemiparesis.O acidente vascular encefálico (AVE) pode acarretar a perda total e/ou parcial da função de um dos membros superiores, sendo sua reabilitação um dos focos principais dos fisioterapeutas. O objetivo foi console Nintendo Wii™. Foram incluídos 10 participantes no estudo com idade média de 64,5±9,54 não tendo demonstrado resultados significativos quando comparado os momentos, apenas um pequeno efeito (d=0,23) foi encontrado em membro superior esquerdo no NHPT. Conclui-se então que não houve melhora significativa na capacidade funcional de membros superiores utilizando realidade virtual em indivíduos com hemiparesia

EFEITO DA TERAPIA COM REALIDADE VIRTUAL NO EQUILÍBRIO DINÂMICO DE INDIVÍDUOS PÓS-ACIDENTE VASCULAR ENCEFÁLICO

The aim of this study was to analyze the effect of virtual reality-based (VR) therapy on balance training of patients after stroke. 10 hemiparetic participants received twelve individual physical therapy sessions using the VR therapeutic, through Nintendo Wii® Fit Plus and Wii Sports Resort™. The analysis revealed that the Dynamic Gait Index (DGI) instrument, responsible for evaluating the dynamic balance, obtained significant difference (p=0.0085) between the basal (17.30±3.59) and final (20.30±2.94) evaluation. The Penguin Slide game had no significance between the scores (p=0.918), but there was a moderate correlation between the DGI instrument (r=0.662; p=0.037). This study obtained favorable results related to dynamic balance and also suggests that VR therapy as in general influenced the improvement of dynamic balance in individuals with hemiparesis after stroke.O objetivo desse estudo foi analisar o efeito da terapia com Realidade Virtual (RV) no equilíbrio dinâmico de indivíduos pós Acidente Vascular Encefálico (AVE). Participaram dez indivíduos com hemiparesia, que receberam doze sessões individuais de fisioterapia com utilização da modalidade terapêutica RV, por meio do Nintendo Wii® Fit Plus e o Wii Sports Resort™. A análise revelou que o instrumento Dynamic Gait Index (DGI), responsável por avaliar o equilíbrio dinâmico, obteve diferença significativa (p=0,0085) entre a avaliação inicial (17,30±3,59) e final (20,30±2,94). O jogo Penguin Slide não obteve significância entre as pontuações (p=0,918), mas houve uma correlação moderada entre o instrumento DGI (r=0,662; p=0,037). Esse estudo obteve resultados favoráveis relacionados ao equilíbrio dinâmico e também sugere que a terapia com RV como um todo influenciou a melhora do equilíbrio dinâmico dos indivíduos com hemiparesia pós AVE

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Angiogenic transforming capacity of IgG purified from plasma of type 1 diabetic patients

We previously demonstrated that plasma of type 1 diabetic patients contains antibodies complexed irreversibly with Grp94 that also display proteolytic activity. In this work, we wanted to test whether antibodies obtained from diabetic plasma may convey an inflammatory risk on vascular cells. To this aim, IgG were purified on the Protein-G column from individual plasma of eight type 1 diabetic patients, and then tested on HUVECs to measure effects on cell growth and morphologic changes at different incubation times. The purified fractions of IgG contained a significant amount of Fab/(Fab)(2), both free and in big aggregates, and anti-Grp94 antibodies, mostly irreversibly linked with, but also free of Grp94. The purified fractions of both Fab/(Fab)(2) and whole IgG stimulated the proliferation and sustained the angiogenic differentiation of human umbilical vein endothelial cells (HUVECs) at sub-nanomolar concentrations. IgG from normal plasma neither stimulated the cell growth nor induced any differentiation of HUVECs. The maximum cell growth stimulation occurred at 6-9 hrs and associated with the strong activation of the ERK1/2 pathway, whereas angiogenic transformation was completed later when the ERK1/2 activation was silenced and cell growth stimulation significantly reduced. Neither proteolytic activity of MMP-9 nor VEGF were apparently involved in mediating the angiogenic differentiation of HUVECs that mostly correlated with an increased expression of HSP70 closely coupled with cell membrane-bound inactive species of MMP-9. Results indicate that effects displayed on HUVECs by antibodies purified from diabetic plasma are likely sustained by immune complexes with Grp94 that may thus predict an increased risk of angiogenic transformation in vivo

Characterization of immune complexes of idiotypic catalytic and anti-idiotypic inhibitory antibodies in plasma of type 1 diabetic subjects

An increase in proteolytic activity is an early common feature of diabetes, and is associated with the development of vascular complications. We performed an extensive proteomic investigation on plasma of type 1 diabetic subjects to discover why some of them apparently lacked any measurable proteolytic activity. Activity was found enclosed in immune complexes in which Fab/(Fab)(2) displayed a serine-like catalytic activity. Disaggregation of complexes by means of Protein G affinity chromatography led to the separation of free subunits of Fab, showing a specific amidolytic activity, from Fab that displayed activity on casein and remained closely complexed with whole IgG. On both types of Fab the serine catalytic site appeared to be the same, being located in close vicinity to the antigen-binding site. The distinct substrate specificity was due to the different conformation adopted by the catalytic site depending on the structure of Fab/(Fab)(2), whether in complexes or as free subunits. Catalytic Fab/(Fab)(2) originated from idiotypic antibodies developed against Grp94, identified as the primary antigen covalently complexed with Fab. Whole IgG present in immune complexes were instead mostly formed with anti-idiotypic antibodies developed against the adduct of Fab/(Fab)(2) with Grp94, and were responsible for blocking any catalytic activity. In dot-blot experiments with native Grp94, we confirmed that in any diabetic plasma circulated anti-Grp94, idiotypic, and anti-idiotypic antibodies