Using the gross motor function measure evolution ratio to compare different dosage of hyperbaric treatment with conventional therapies in children with cerebral palsy – could it end the controversy?

The Gross Motor Function Measure is used in most studies measuring gross motor function in children with cerebral palsy. In many studies, including those evaluating the effect of hyperbaric treatment, the Gross Motor Function Measure variations were potentially misinterpreted because of the lack of control groups. The Gross Motor Function Measure Evolution Ratio (GMFMER) uses historical data from the Gross Motor Function Classification System curves and allows to re-analyze previous published studies which used the Gross Motor Function Measure by considering the natural expected evolution of the Gross Motor Function Measure. As the GMFMER is defined by the ratio between the recorded Gross Motor Function Measure score increase and the expected increase attributed to natural evolution during the duration of the study (natural evolution yields a GMFMER of 1), it becomes easy to assess and compare the efficacy of different treatments.ObjectiveThe objective of this study is to revisit studies done with different dosage of hyperbaric treatment and to compare the GMFMER measured in these studies with those assessing the effects of various recommended treatments in children with cerebral palsy.MethodsPubMed Searches were conducted to included studies that used the Gross Motor Function Measure to evaluate the effect of physical therapy, selective dorsal rhizotomy, botulinum toxin injection, hippotherapy, stem cell, or hyperbaric treatment. The GMFMER were computed for each group of the included studies.ResultsForty-four studies were included, counting 4 studies evaluating the effects of various dosage of hyperbaric treatment in children with cerebral palsy. Since some studies had several arms, the GMFMER has been computed for 69 groups. The average GMFMER for the groups receiving less than 2 h/week of physical therapy was 2.5 ± 1.8 whereas in context of very intensive physical therapy it increased to 10.3 ± 6.1. The GMFMER of stem cell, selective dorsal rhizotomy, hippotherapy, and botulinum toxin treatment was, 6.0 ± 5.9, 6.5 ± 2.0, 13.3 ± 0.6, and 5.0 ± 2.9, respectively. The GMFMER of the groups of children receiving hyperbaric treatment were 28.1 ± 13.0 for hyperbaric oxygen therapy and 29.8 ± 6.8 for hyperbaric air.ConclusionThe analysis of the included studies with the GMFMER showed that hyperbaric treatment can result in progress of gross motor function more than other recognized treatments in children with cerebral palsy

L'oxygénothérapie hyperbare dans le traitement de la paralysie cérébrale : arnaque ou traitement approprié?

L'oxygénothérapie hyperbare (OTH) consiste à soumettre un patient à des taux de pression plus élevés que la pression atmosphérique normale et de lui faire respirer 100 % d'oxygène. Cette approche a été mise à l'essai pour le traitement de nombreuses conditions médicales avec succès dans certains cas alors pour d'autres sa validité reste encore à démontrer. Dans le cas de la paralysie cérébrale son utilisation a soulevé de nombreuses controverses et les études conduites jusqu'alors n'ont pas encore convaincu tous les membres de la communauté scientifique et ce, malgré certains effets positifs mis en évidence. Une récente étude qui a montré des améliorations notables chez des enfants atteints de paralysie cérébrale (PC) traités avec de l'air légèrement pressurisé, de même que chez ceux traités avec un protocole standard pour l'oxygénothérapie hyperbare (l'OTH), est invoquée pour nier l'efficacité de l'OTH. Des considérations politiques et économiques, plutôt que purement scientifiques, jouent un rôle important dans cette controverse. Des recherches systématiques supplémentaires sont requises, mais entre-temps, comme les effets thérapeutiques de cette approche semblent plus importants que ceux des thérapies actuellement acceptées dans le traitement de la paralysie cérébrale, les enfants atteints de cette condition ne devraient pas se faire refuser l'accès à l'OTH.Hyperbaric oxygen therapy (HBO) consist of subjecting a patient to elevated atmospheric pressure while the patient breathes 100% oxygen. This approach is considered the accepted treatment of choice for a number of medical conditions with success. In certain other conditions, the efficacy is still yet to demonstrated. In the case of cerebral palsy, the utilization of HBO has raised a number of controversial issues in the studies conducted. It has yet to convince the members of the scientific community at large. This unfortunately has been interpreted as negative despite the positive reproducible evidence. Until now, the Canadian government has had reservations concerning the efficacy of this treatment for cerebral palsy. Elsewhere, in the United States and in Quebec there is a certain interest. Specific events in the eyes of some, lead us to believe that the reticence to recognize Hyperbaric oxygen therapy as an effective treatment of cerebral palsy is more based on politics and economics rather than on the science that is available to support its use

Expected Performance of a Self-Coherent Camera

Residual wavefront errors in optical elements limit the performance of coronagraphs. To improve their efficiency, different types of devices have been proposed to correct or calibrate these errors. In this paper, we study one of these techniques proposed by Baudoz et al. 2006 and called Self-Coherent Camera (SCC). The principle of this instrument is based on the lack of coherence between the stellar light and the planet that is searched for. After recalling the principle of the SCC, we simulate its performance under realistic conditions and compare it with the performance of differential imaging.Comment: 6 pages, 4 figure

Interventions used by allied health professionals in sexual rehabilitation after stroke : a systematic review

Background: Although sexuality can be affected post-stroke, few individuals receive sexual rehabilitation because of clinicians’ lack of knowledge regarding evidence-based interventions. Objective: To document and describe the best available evidence supporting interventions that target post-stroke rehabilitation of sexuality. Methods: This systematic review searched the databases Medline, Embase, Psycinfo, CINAHL, Web of science, PEDRO and OTSeeker up to 29 May 2020. Inclusion criteria were: published studies with a sample composed of ≥ 50% stroke clients and describing an intervention that could be applied by an allied health professional. Data was extracted according to the PRISMA guidelines by two independent reviewers. Interventions were described according to the Template for intervention description and replication checklist. Results: Among the 2446 articles reviewed, 8 met the inclusion criteria. Two randomized controlled trials (RCT) and one non-RCT showed improvement in sexual functioning and satisfaction following a 30–45-minute structured rehabilitation program. Two other RCT showed significant improvement in sexual functioning with physical therapy oriented toward 1) structured physical and verbal sexual counseling and 2) pelvic floor muscle training. Three studies showed that interdisciplinary sexual rehabilitation improved satisfaction and sexual functioning; implementation of an interview script for clinicians improved the proportion of clients who addressed sexuality from 0 to 80% in 10 months; and two-day couple retreats improved perceived intimacy between couples. Conclusions: This review highlights promising interventions that could orient future research and improve the access to sexual rehabilitation services for post-stroke, with structured sexual rehabilitation and pelvic floor muscle training being the most strongly supported

The Fast Atmospheric Self-Coherent Camera Technique: Laboratory Results and Future Directions

Direct detection and detailed characterization of exoplanets using extreme adaptive optics (ExAO) is a key science goal of future extremely large telescopes (ELTs). However, wavefront errors will limit the sensitivity of this endeavor. Limitations for ground-based telescopes arise from both quasi-static and residual AO-corrected atmospheric wavefront errors, the latter of which generates short-lived aberrations that will average into a halo over a long exposure. We have developed and tested the framework for a solution to both of these problems using the self-coherent camera (SCC), to be applied to ground-based telescopes, called the Fast Atmospheric SCC Technique (FAST). In this paper we present updates of new and ongoing work for FAST, both in numerical simulation and in the laboratory. We first present numerical simulations that illustrate the scientific potential of FAST, including, with current 10-m telescopes, the direct detection of exoplanets reflected light and exo-Jupiters in thermal emission and, with future ELTs, the detection of habitable exoplanets. In the laboratory, we present the first characterizations of our proposed, and now fabricated, coronagraphic masks.Comment: submitted to Proceedings of Adaptive Optics for Extremely Large Telescopes

Genetic diversity of Mycoplasma hyopneumoniae isolates of abattoir pigs

Mycoplasma hyopneumoniae, the causative agent of porcine enzootic pneumonia, is present in swine herds worldwide. However, there is little information on strains infecting herds in Canada. A total of 160 swine lungs with lesions suggestive of enzootic pneumonia originating from 48 different farms were recovered from two slaughterhouses and submitted for gross pathology. The pneumonic lesion scores ranged from 2% to 84%. Eighty nine percent of the lungs (143/160) were positive for M. hyopneumoniae by real-time PCR whereas 10% (16/160) and 8.8% (14/160) were positive by PCR for M. hyorhinis and M. flocculare, respectively. By culture, only 6% of the samples were positive for M. hyopneumoniae (10/160). Among the selected M. hyopneumoniae-positive lungs (n = 25), 9 lungs were co-infected with M. hyorhinis, 9 lungs with PCV2, 2 lungs with PRRSV, 12 lungs with S. suis and 10 lungs with P. multocida. MLVA and PCR-RFLP clustering of M. hyopneumoniae revealed that analyzed strains were distributed among three and five clusters respectively, regardless of severity of lesions, indicating that no cluster is associated with virulence. However, strains missing a specific MLVA locus showed significantly less severe lesions and lower numbers of bacteria. MLVA and PCR-RFLP analyses also showed a high diversity among field isolates of M. hyopneumoniae with a greater homogeneity within the same herd. Almost half of the field isolates presented less than 55% homology with selected vaccine and reference strains