Study on the Usefulness of Sit to Stand Training in Self-directed Treatment of Stroke Patients

Abstract. [Purpose] This study sought to determine the usefulness of sit to stand training in self-directed treatment of stroke patients. It examined the effect that sit to stand training has on balance and functional movement depending on the form of support surfaces. [Subjects and Methods] Thirty stroke patients were randomly sampled and divided into an unstable support surface group (15) and stable support surface group (15). In order to identify the effect depending on the form of support surfaces, 15 minutes of support surface training plus + 15 minutes of free gait training was performed. [Results] The results of the unstable support surface training showed that the corresponding sample t-test results were significant for the 7-item 3-point Berg balance scale, timed Up and Go test, and 6-minute walking test. The independent samples t-test, showed that there were significant outcomes in step length on the affected side, and step length on the unaffected side. [Conclusion] In conclusion, the sit to stand training on stable support surfaces was not as effective as the training using unstable support surfaces, but it is a simple and stable exercise with less risk of falls during training. It can also be performed alone by the patient in order to increase endurance and dynamic balance ability. Therefore, it is considered a useful exercise that can be performed alone by the patient outside the treatment room

Mapping the Complex Morphology of Cell Interactions with Nanowire Substrates Using FIB-SEM

Using high resolution focused ion beam scanning electron microscopy (FIB-SEM) we study the details of cell-nanostructure interactions using serial block face imaging. 3T3 Fibroblast cellular monolayers are cultured on flat glass as a control surface and on two types of nanostructured scaffold substrates made from silicon black (Nanograss) with low- and high nanowire density. After culturing for 72 hours the cells were fixed, heavy metal stained, embedded in resin, and processed with FIB-SEM block face imaging without removing the substrate. The sample preparation procedure, image acquisition and image post-processing were specifically optimised for cellular monolayers cultured on nanostructured substrates. Cells display a wide range of interactions with the nanostructures depending on the surface morphology, but also greatly varying from one cell to another on the same substrate, illustrating a wide phenotypic variability. Depending on the substrate and cell, we observe that cells could for instance: break the nanowires and engulf them, flatten the nanowires or simply reside on top of them. Given the complexity of interactions, we have categorised our observations and created an overview map. The results demonstrate that detailed nanoscale resolution images are required to begin understanding the wide variety of individual cells' interactions with a structured substrate. The map will provide a framework for light microscopy studies of such interactions indicating what modes of interactions must be considered

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Role of endogenous 4-1BB in the development of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is characterized by the production of autoantibodies directed against nuclear antigens including nucleosomes and DNA. To determine the role of T-cell costimulatory molecule 4-1BB in the regulation of SLE, MRL-Faslpr (lpr) mice deficient in 4-1BB (lpr/4-1BB–/–) were generated and their disease phenotype was compared to that of control lpr mice. The main finding of this study is that the lpr/4-1BB–/– mice had more pronounced skin lesions which appeared earlier, increased lymphadenopathy, increased renal damage, and higher mortality than 4-1BB-intact control lpr mice. The increased severity of lesions in lpr/4-1BB–/– mice was closely associated with increases in CD4+ T, CD3+ B220+ double-negative T cells, serum immunoglobulin, anti-dsDNA autoantibodies, and tissue immunoglobulin deposits. These data suggest that the 4-1BB−4-1BB ligand signalling pathway plays an important role in SLE and that deletion of 4-1BB confers susceptibility to lpr mice, leading to accelerated induction of disease and early mortality

Autism

Autism spectrum disorder (ASD) is a complex, lifelong neurodevelopmental condition that is marked by deficits in social communication and interaction, and repetitive or restrictive patterns of behavior, interests, or activities. These symptoms can create challenges for individuals on the autism spectrum and their parents during the transition to adulthood, which may interfere with their ability to access and receive adequate and appropriate health care. Awareness of how the challenges associated with ASD may translate to healthcare barriers can help primary care providers address the complex needs of individuals who are on the autism spectrum and mitigate the risks of additional health disparities. This chapter starts with a case presentation to illustrate key considerations for serving a patient population with ASD and the differences between a medical versus social model of disability, then provides an overview of ASD and its common comorbidities and risk factors, discussion about special issues that arise during the transition to adulthood, common interventions for individuals on the autism spectrum, as well as practical tips to facilitate health care