Comparison between Ischemic and Hemorrhagic Strokes in Functional Outcome at Discharge from an Intensive Rehabilitation Hospital

Comparison studies on recovery outcomes in ischemic (IS) and hemorrhagic strokes (HS) have yielded mixed results. In this retrospective observational study of consecutive IS and HS patients, we aimed at evaluating functional outcomes at discharge from an intensive rehabilitation hospital, comparing IS vs. HS, analyzing possible predictors. Modified Rankin Scale (mRS) at discharge was the main outcome. Out of the 229 patients included (mean age 72.9 ± 13.9 years, 48% males), 81 had HS (35%). Compared with IS (n = 148), HS patients were significantly younger (75 ± 12.5 vs. 68.8 ± 15.4 years, p = 0.002), required longer hospitalizations both in acute (23.9 ± 36.7 vs. 35.2 ± 29.9 days, p = 0.019) and rehabilitation hospitals (41.5 ± 31.8 vs. 77.2 ± 51.6 days, p = 0.001), and had more severe initial clinical deficit (mean number of neurological impairments: 2.0 ± 1.1 vs. 2.6 ± 1.4, p = 0.001) and mRS scores at admission (p = 0.046). At discharge, functional status change, expressed as mRS, was not significantly different between IS and HS (F = 0.01, p = 0.902), nor was the discharge destination (p = 0.428). Age and clinical severity were predictors of functional outcome in both stroke types. On admission in an intensive rehabilitation hospital, HS patients presented a worse functional and clinical status compared to IS. Despite this initial gap, the two stroke types showed an overlapped trajectory of functional recovery, with age and initial stroke severity as the main prognostic factors

The brief international cognitive assessment for multiple sclerosis (BICAMS): Normative values with gender, age and education corrections in the Italian population

Background: BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) has been recently developed as brief, practical and universal assessment tool for cognitive impairment in MS subjects. It includes the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test-2 (CVLT2) and the Brief Visuospatial Memory Test-Revised (BVMT-R) . In this study we aimed at gathering regression based normative data for the BICAMS battery in the Italian population.Methods: Healthy subjects were consecutively recruited among patient friends and relatives. Corrections for demographics were calculated using multivariable linear regression models. Test-retest reliability was assessed using the Pearson correlation coefficient.Results: The BICAMS battery was administered to 273 healthy subjects (180 women, mean age 38.9 ± 13.0 years, mean education 14.9 ± 3.0 years). Test-retest reliability was good for all the tests.Conclusions: The study provided normative data of the BICAMS for the Italian population confirming good test-retest reliability which can facilitate the use of the battery in clinical practice, also for longitudinal patient assessments

Improving the Characterization of Radiologically Isolated Syndrome Suggestive of Multiple Sclerosis

OBJECTIVE: To improve the characterization of asymptomatic subjects with brain magnetic resonance imaging (MRI) abnormalities highly suggestive of multiple sclerosis (MS), a condition named as "radiologically isolated syndrome" (RIS). METHODS: Quantitative MRI metrics such as brain volumes and magnetization transfer (MT) were assessed in 19 subjects previously classified as RIS, 20 demographically-matched relapsing-remitting MS (RRMS) patients and 20 healthy controls (HC). Specific measures were: white matter (WM) lesion volumes (LV), total and regional brain volumes, and MT ratio (MTr) in lesions, normal-appearing WM (NAWM) and cortex. RESULTS: LV was similar in RIS and RRMS, without differences in distribution and frequency at lesion mapping. Brain volumes were similarly lower in RRMS and RIS than in HC (p<0.001). Lesional-MTr was lower in RRMS than in RIS (p = 0.048); NAWM-MTr and cortical-MTr were similar in RIS and HC and lower (p<0.01) in RRMS. These values were particularly lower in RRMS than in RIS in the sensorimotor and memory networks. A multivariate logistic regression analysis showed that 13/19 RIS had ≥70% probability of being classified as RRMS on the basis of their brain volume and lesional-MTr values. CONCLUSIONS: Macroscopic brain damage was similar in RIS and RRMS. However, the subtle tissue damage detected by MTr was milder in RIS than in RRMS in clinically relevant brain regions, suggesting an explanation for the lack of clinical manifestations of subjects with RIS. This new approach could be useful for narrowing down the RIS individuals with a high risk of progression to MS

Studi Perencanaan Dinding Turap (Sheet Pile) Pada Proyek Perkuatan Struktur Dermaga Terminal Berlian Pelabuhan Tanjung Perak Surabaya

Dermaga merupakan suatu bangunan atau infrastruktur yang sangat penting bagi perekonomian suatu daerah maupun negara, di Jawa Timur tepatnya di pelabuhan Tanjung Perak kota Surabaya, yaitu dermaga Berlian yang berfungsi sebagai bongkar muat peti kemas, dibangun sejak tahun 1910. Dermaga Berlian ini memiliki konstruksi bertipe Jetty tertutup dengan struktur dinding blok kaison beton. Seiring berjalan waktu arus peti kemas domestic dermaga Berlian meningkat dari tahun ke tahun. Namun, dermaga Berlian yang dibangung sejak masa kolonial Belanda ini diduga mengalami pengeroposan pada kaison eksistingnya sehingga pasir keluar ke sisi laut menyebabkan kegiatan di dermaga kurang maksimal sehingga diperlukan perkuatan strukturnya. Dalam perencanaan perkuatan struktur ini direncanakan menggunakan dinding turap profil pipa baja yang dipancangkan di area sisi laut dan diisi dengan beton mutu K-430 dengan jarak dari kaison eksisting 2,9 m dan galian kolam dermaga sedalam 14 m. dalam perencanaan ini digunakan metode Kantilever dengan kondisi tanah sesuai dengan aslinya untuk stabilitas dinding turap, lalu dianalisis dengan program bantu Plaxis v8.2. Pembebanan dari gaya lateral tanah yang diakibatkan beban diatas dermaga maupun dari berat tanah sendiri, dari hasil perhitungan perkuatan ini antara lain dimensi penampang profil pipa baja 1016 mm ketebalan 14 mm, kedalaman pemancangan dinding turap yaitu 19 m dengan panjang total 37,3 m. dimensi tulangan utama dinding turap yaitu 18 D25 dengan tulangan spiral D13-150