Over- and under-supply of inpatient rehabilitation after stroke without a post-acute rehabilitation system: a nationwide retrospective cohort study

IntroductionThis study aimed to investigate the utilization of post-ischemic stroke rehabilitation prior to the introduction of the post-acute rehabilitation system in South Korea in 2017.MethodsMedical resources utilized for patients with cerebral infarction hospitalized at Regional Cardio-Cerebrovascular Centers (RCCVCs) of 11 tertiary hospitals were tracked until 2019. Stroke severity was classified according to the National Institutes of Health Stroke Scale (NIHSS), and multivariate regression analysis was performed to analyze factors influencing the length of hospital stay (LOS).ResultsThis study included 3,520 patients. Among 939 patients with stroke with moderate or greater severity, 209 (22.3%) returned home after RCCVC discharge without inpatient rehabilitation. Furthermore, 1,455 (56.4%) out of 2,581 patients with minor strokes with NIHSS scores ≤4 were readmitted to another hospital for rehabilitation. The median LOS of patients who received inpatient rehabilitation after RCCVC discharge was 47 days. During the inpatient rehabilitation period, the patients were admitted to 2.7 hospitals on average. The LOS was longer in the lowest-income group, high-severity group, and women.ConclusionBefore the introduction of the post-acute rehabilitation system, treatment after stroke was both over- and under-supplied, thus delaying home discharge. These results support the development of a post-acute rehabilitation system that defines the patients, duration, and intensity of rehabilitation

Inhibitory Synapses Are Repeatedly Assembled and Removed at Persistent Sites In Vivo

Older concepts of a hard-wired adult brain have been overturned in recent years by in vivo imaging studies revealing synaptic remodeling, now thought to mediate rearrangements in microcircuit connectivity. Using three-color labeling and spectrally resolved two-photon microscopy, we monitor in parallel the daily structural dynamics (assembly or removal) of excitatory and inhibitory postsynaptic sites on the same neurons in mouse visual cortex in vivo. We find that dynamic inhibitory synapses often disappear and reappear again in the same location. The starkest contrast between excitatory and inhibitory synapse dynamics is on dually innervated spines, where inhibitory synapses frequently recur while excitatory synapses are stable. Monocular deprivation, a model of sensory input-dependent plasticity, shortens inhibitory synapse lifetimes and lengthens intervals to recurrence, resulting in a new dynamic state with reduced inhibitory synaptic presence. Reversible structural dynamics indicate a fundamentally new role for inhibitory synaptic remodeling—flexible, input-specific modulation of stable excitatory connections.National Eye Institute (Grant RO1 EY017656 and RO1 EY011894)National Institutes of Health (U.S.) (P41EB015871-26A1, 4R44EB012415-02, and NSF CBET-0939511)Singapore-MIT AllianceSingapore-MIT Alliance for Research and Technology CenterRuth L. Kirschstein National Research Service Award (F31AG044061)National Institutes of Health (U.S.) (Pre-Doctoral Training Grant T32GM007287

Photodynamic Therapy for Subretinal New Vessels

Photodynamic therapy (PDT) involves the induction of endothelial cell death or occlusion of blood vessels. On the basis of this mechanism of action, PDT is used in the treatment of predominant classic choroidal neovascularization (CNV), if the classic component is over 50%, and in myopic CNV. This study describes 2 cases of distinctive, abnormal, large, subretinal new vessels that are thought to have originated from the choroids. Diminishment of the new vessels was observed following treatment with PDT

In Vitro inhibitory activity of Alpinia katsumadai extracts against influenza virus infection and hemagglutination

<p>Abstract</p> <p>Background</p> <p><it>Alpinia katsumadai </it>(AK) extracts and fractions were tested for <it>in vitro </it>antiviral activities against influenza virus type A, specially human A/PR/8/34 (H1N1) and avian A/Chicken/Korea/MS96/96 (H9N2), by means of time-of-addition experiments; pre-treatment, simultaneous treatment, and post treatment.</p> <p>Results</p> <p>In pre-treatment assay, the AK extracts and AK fractions did not show significant antiviral activity. During the simultaneous treatment assay, one AK extract and five AK fractions designated as AK-1 to AK-3, AK-5, AK-10, and AK-11 showed complete inhibition of virus infectivity against A/PR/8/34 (H1N1) and A/Chicken/Korea/MS96/96 (H9N2). The 50% effective inhibitory concentrations (EC₅₀) of these one AK extracts and five AK fractions with exception of the AK-9 were from 0.8 ± 1.4 to 16.4 ± 4.5 <it>μ</it>g/mL against A/PR/8/34 (H1N1). The two AK extracts and three AK fractions had EC₅₀values ranging from <0.39 ± 0.4 to 2.3 ± 3.6 <it>μ</it>g/mL against A/Chicken/Korea/MS96/96 (H9N2). By the hemagglutination inhibition (HI) assay, the two AK extracts and five AK fractions completely inhibited viral adsorption onto chicken RBCs at less than 100 <it>μ</it>g/mL against both A/PR/8/34 (H1N1) and A/Chicken/Korea/MS96/96 (H9N2). Interestingly, only AK-3 was found with inhibition for both viral attachment and viral replication after showing extended antiviral activity during the post treatment assay and quantitative real-time PCR.</p> <p>Conclusions</p> <p>These results suggest that AK extracts and fractions had strong anti-influenza virus activity that can inhibit viral attachment and/or viral replication, and may be used as viral prophylaxis.</p

One-Step Generation of a Drug-Releasing Hydrogel Microarray-On-A-Chip for Large-Scale Sequential Drug Combination Screening

Large-scale screening of sequential drug combinations, wherein the dynamic rewiring of intracellular pathways leads to promising therapeutic effects and improvements in quality of life, is essential for personalized medicine to ensure realistic cost and time requirements and less sample consumption. However, the large-scale screening requires expensive and complicated liquid handling systems for automation and therefore lowers the accessibility to clinicians or biologists, limiting the full potential of sequential drug combinations in clinical applications and academic investigations. Here, a miniaturized platform for high-throughput combinatorial drug screening that is &quot;pipetting-free&quot; and scalable for the screening of sequential drug combinations is presented. The platform uses parallel and bottom-up formation of a heterogeneous drug-releasing hydrogel microarray by self-assembly of drug-laden hydrogel microparticles. This approach eliminates the need for liquid handling systems and time-consuming operation in high-throughput large-scale screening. In addition, the serial replacement of the drug-releasing microarray-on-a-chip facilitates different drug exchange in each and every microwell in a simple and highly parallel manner, supporting scalable implementation of multistep combinatorial screening. The proposed strategy can be applied to various forms of combinatorial drug screening with limited amounts of samples and resources, which will broaden the use of the large-scale screening for precision medicine

Glucagon-Like Peptide-1 Receptor Agonist Differentially Affects Brain Activation in Response to Visual Food Cues in Lean and Obese Individuals with Type 2 Diabetes Mellitus

Background: To investigate the effects of a glucagon-like peptide-1 receptor agonist on functional brain activation in lean and obese individuals with type 2 diabetes mellitus (T2DM) in response to visual food cues. Methods: In a randomized, single-blinded, crossover study, 15 lean and 14 obese individuals with T2DM were administered lixisenatide or normal saline subcutaneously with a 1-week washout period. We evaluated brain activation in response to pictures of high-calorie food, low-calorie food, and nonfood using functional magnetic resonance imaging and measured appetite and caloric intake in participants who were given access to an ad libitum buffet. Results: Obese individuals with T2DM showed significantly greater activation of the hypothalamus, pineal gland, parietal cortex (high-calorie food vs. low-calorie food, P&lt;0.05), orbitofrontal cortex (high-calorie food vs. nonfood, P&lt;0.05), and visual cortex (food vs. nonfood, P&lt;0.05) than lean individuals with T2DM. Lixisenatide injection significantly reduced the functional activation of the fusiform gyrus and lateral ventricle in obese individuals with T2DM compared with that in lean individuals with T2DM (nonfood vs. high-calorie food, P&lt; 0.05). In addition, in individuals who decreased their caloric intake after lixisenatide injection, there were significant interaction effects between group and treatment in the posterior cingulate, medial frontal cortex (high-calorie food vs. low-calorie food, P &lt; 0.05), hypothalamus, orbitofrontal cortex, and temporal lobe (food vs. nonfood, P&lt; 0.05). Conclusion: Brain responses to visual food cues were different in lean and obese individuals with T2DM. In addition, acute administration of lixisenatide differentially affected functional brain activation in these individuals, especially in those who decreased their caloric intake after lixisenatide injection.Y

Active Surveillance of Adverse Events Following Immunization against Pandemic Influenza A (H1N1) in Korea

SUMMARY: Surveillance of vaccine safety is one of the public health interventions used to investigate the causal relationship between vaccines and adverse events. Using active surveillance data, we aimed to compile a detailed summary describing the safety of the pandemic influenza A (H1N1) vaccine. Computer-assisted telephone interview was used to investigate adverse events for 9,000 subjects who ha