Functional Recovery of the Paretic Upper Limb After Stroke: Who Regains Hand Capacity?

Objective: To describe recovery of upper limb capacity after stroke during inpatient rehabilitation based on the Stroke Upper Limb Capacity Scale (SULCS). Design: Prospective observational study. Setting: Inpatient department of a rehabilitation center. Participants: Patients with stroke (N=299) admitted to a specialized stroke rehabilitation center. Intervention: Not applicable. Main Outcome Measures: Upper limb capacity was assessed at the start and end of the rehabilitation phase with the SULCS (range, 0-10). The following demographic and clinical characteristics were registered: age, sex, side of stroke, stroke type, time since stroke, and length of stay in the rehabilitation center. Results: On admission, 125 patients had no hand capacity (SULCS score, 0-3), 58 had basic hand capacity (SULCS score, 4-7), and 116 had advanced hand capacity (SULCS score, 8-10). Of the patients without initial hand capacity, 41% regained some hand capacity (SULCS score, ≥4) at discharge. Of these, patients with SULCS scores of 2 and 3 had 29 and 97 times greater chance of regaining some hand capacity compared with patients with an initial SULCS score of 0, respectively. Of the patients with initial basic hand capacity, 78% regained advanced hand capacity at discharge. The SULCS score on admission explained 51% of the SULCS score variance at discharge, while time since stroke was negatively associated with upper limb recovery, explaining an additional 7% of the SULCS score variance at discharge. Conclusions: Even patients with minimal proximal shoulder and elbow control of the upper paretic limb on admission in a rehabilitation center have a fair chance of regaining some hand capacity in the long-term after stroke, whereas patients without such proximal arm control have a much poorer prognosis for regaining hand capacity

Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes.

Contains fulltext : 49893.pdf (publisher's version ) (Open Access)BACKGROUND: Type 2 diabetes (DM) is a strong risk factor for tuberculosis (TB) and is associated with a slower response to TB treatment and a higher mortality rate. Because lower concentrations of anti-TB drugs may be a contributing factor, we compared the pharmacokinetics of rifampicin in patients with TB, with and without DM. METHODS: Seventeen adult Indonesian patients with TB and DM and 17 age- and sex-matched patients with TB and without DM were included in the study during the continuation phase of TB treatment. All patients received 450 mg of rifampicin (10 mg/kg) and 600 mg of isoniazid 3 times weekly. Steady-state plasma concentrations of rifampicin and its metabolite desacetylrifampicin were assessed at 0, 2, 4, and 6 h after drug intake. RESULTS: Geometric means of rifampicin exposure (AUC(0-6 h)) were 12.3 mg x h/L (95% confidence interval [CI], 8.0-24.2) in patients with TB and DM, and 25.9 mg x h/L (95% CI, 21.4-40.2) in patients with TB only (P=.003). Similar differences were found for the maximum concentration of rifampicin. No significant differences in time to maximum concentration of rifampicin were observed. The AUC(0-6 h) of desacetylrifampicin was also much lower in patients with TB and DM versus patients with TB only (geometric mean, 0.60 vs. 3.2 mg x h/L; P=.001). Linear regression analysis revealed that higher body weight (P<.001), the presence of DM (P=.06), and plasma glucose concentration (P=.016) were correlated with exposure to rifampicin. CONCLUSION: Exposure (AUC(0-6 h)) to rifampicin was 53% lower in Indonesian patients with TB and DM, compared with patients with TB only. Patients with TB and DM who have a higher body weight may need a higher dose of rifampicin

How Do Fugl-Meyer Arm Motor Scores Relate to Dexterity According to the Action Research Arm Test at 6 Months Poststroke?

Objective To determine the optimal cutoff scores for the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) with regard to predicting no, poor, limited, notable, or full upper-limb capacity according to frequently used cutoff points for the Action Research Arm Test (ARAT) at 6 months poststroke. Design Prospective. Setting Rehabilitation center. Participants Patients (N=460) with a first-ever ischemic stroke at 6 months poststroke. Interventions Not applicable. Main Outcome Measures Based on the ARAT classification of poor to full upper-limb capacity, receiver operating characteristic curves were used to calculate the area under the curve, optimal cutoff points for the FMA-UE were determined, and a weighted kappa was used to assess the agreement. Results FMA-UE scores of 0 through 22 represent no upper-limb capacity (ARAT 0-10); scores of 23 through 31 represent poor capacity (ARAT 11-21); scores of 32 through 47 represent limited capacity (ARAT 22-42); scores of 48 through 52 represent notable capacity (ARAT 43-54); and scores of 53 through 66 represent full upper-limb capacity (ARAT 55-57). Overall, areas under the curve ranged from.916 (95% confidence interval [CI],.890-.943) to.988 (95% CI,.978-.998; P31 points correspond to no to poor arm-hand capacity (ie, ≤21 points) on the ARAT, whereas FMA-UE scores >31 correspond to limited to full arm-hand capacity (ie, >22 points) on the ARAT

Impact of Velvet Complex on Transcriptome and Penicillin G Production in Glucose-Limited Chemostat Cultures of a β-Lactam High-Producing Penicillium chrysogenum Strain

The multicomponent global regulator Velvet complex has been identified as a key regulator of secondary metabolite production in Aspergillus and Penicillium species. Previous work indicated a massive impact of PcvelA and PclaeA deletions on penicillin production in prolonged batch cultures of P. chrysogenum, as well as substantial changes in transcriptome. The present study investigated the impact of these mutations on product formation and genome-wide transcript profiles under glucose-limited aerobic conditions, relevant for industrial production of β-lactams. Predicted amino acid sequences of PcVelA and PcLaeA in this strain were identical to those in its ancestor Wisconsin54-1255. Controls were performed to rule out transformation-associated loss of penicillin-biosynthesis clusters. The correct PcvelA and PclaeA deletion strains revealed a small reduction of penicillin G productivity relative to the reference strain, which is a much smaller reduction than previously reported for prolonged batch cultures of similar P. chrysogenum mutants. Chemostat-based transcriptome analysis yielded only 23 genes with a consistent differential response in the PcvelAΔ and PclaeAΔ mutants when grown in the absence of the penicillin G side-chain precursor phenylacetic acid. Eleven of these genes belonged to two small gene clusters, one of which contained a gene with high homology to the aristolochene synthase. These results provide a clear caveat that the impact of the Velvet complex on secondary metabolism in filamentous fungi is strongly context dependent