The Impact of Timing and Dose of Rehabilitation Delivery on Functional Recovery of Stroke Patients

BackgroundTo investigate the impact of both timing and dose of rehabilitation delivery on the functional recovery of stroke patients.MethodsFrom chart review, we included 76 patients who were admitted to a regional hospital for first-ever stroke, and who had received multidisciplinary rehabilitation programs including physical therapy (PT) and occupational therapy (OT) at the inpatient department, and continuous rehabilitation therapy at the outpatient department for at least 3 months. The collected data included age, sex, type of stroke (hemorrhage/infarction), onset of stroke, initial motor status by Brunnstrom's motor recovery stages, time to rehabilitation intervention (from onset of stroke), length of stay, existence of aphasia, craniotomy (yes/no), and total units of rehabilitation. Main outcome measures were serial Barthel Index (BI) at initial assessment, 1 month, 3 months, 6 months, and 1 year post-stroke.ResultsAge was inversely correlated with BI and BI improvement at 3 months and 6 months post-stroke. Rehabilitation intervention time from onset was negatively correlated with BI improvement at 1 month and 1 year, and with BI at 1 month, 3 months, 6 months, and 1 year post-stroke. The total units of inpatient PT and/or OT were positively correlated with BI improvement at 1 month, 3 months, and 6 months post-stroke. The total units of PT and/or OT were positively correlated with BI improvement at 3 months and 6 months post-stroke. And the initial BI was positively correlated with BI at 1 month, 3 months, and 6 months post-stroke. The total units of OT can significantly predict BI improvement at 3 months and 6 months post-stroke, while the initial BI capacity can significantly predict BI status at 1 month, 3 months, and 6 months post-stroke.ConclusionThere is a dose-dependent effect of rehabilitation on functional improvement of stroke patients for the first 6 months post-stroke, and earlier delivery of rehabilitation has lasting effects on the functional recovery of stroke patients up to 1 year

A comprehensive network and pathway analysis of candidate genes in major depressive disorder

<p>Abstract</p> <p>Background</p> <p>Numerous genetic and genomic datasets related to complex diseases have been made available during the last decade. It is now a great challenge to assess such heterogeneous datasets to prioritize disease genes and perform follow up functional analysis and validation. Among complex disease studies, psychiatric disorders such as major depressive disorder (MDD) are especially in need of robust integrative analysis because these diseases are more complex than others, with weak genetic factors at various levels, including genetic markers, transcription (gene expression), epigenetics (methylation), protein, pathways and networks.</p> <p>Results</p> <p>In this study, we proposed a comprehensive analysis framework at the systems level and demonstrated it in MDD using a set of candidate genes that have recently been prioritized based on multiple lines of evidence including association, linkage, gene expression (both human and animal studies), regulatory pathway, and literature search. In the network analysis, we explored the topological characteristics of these genes in the context of the human interactome and compared them with two other complex diseases. The network topological features indicated that MDD is similar to schizophrenia compared to cancer. In the functional analysis, we performed the gene set enrichment analysis for both Gene Ontology categories and canonical pathways. Moreover, we proposed a unique pathway crosstalk approach to examine the dynamic interactions among biological pathways. Our pathway enrichment and crosstalk analyses revealed two unique pathway interaction modules that were significantly enriched with MDD genes. These two modules are neuro-transmission and immune system related, supporting the neuropathology hypothesis of MDD. Finally, we constructed a MDD-specific subnetwork, which recruited novel candidate genes with association signals from a major MDD GWAS dataset.</p> <p>Conclusions</p> <p>This study is the first systematic network and pathway analysis of candidate genes in MDD, providing abundant important information about gene interaction and regulation in a major psychiatric disease. The results suggest potential functional components underlying the molecular mechanisms of MDD and, thus, facilitate generation of novel hypotheses in this disease. The systems biology based strategy in this study can be applied to many other complex diseases.</p

Regulator of the mucoid phenotype A gene increases the virulent ability of extended-spectrum beta-lactamase-producing serotype non-K1/K2 Klebsiella pneumonia

BackgroundTo determine whether the presence of a capsule regulator gene [i.e., regulator of mucoid phenotype A (rmpA) gene] contributes to virulence on extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) with serotype non-K1/K2 strains.MethodsTwenty-eight ESBL-KP and non-ESBL-KP isolates were collected from the Tri-Service General Hospital (Taipei, Taiwan). The impact of the virulent rmpA gene in different capsular polysaccharide serotypes on ESBL-KP and non-ESBL-KP isolates was studied by a neutrophil phagocytosis reaction, a serum bactericidal assay, and an animal survival model.ResultsResistance to broad spectrum antibiotics was more prevalent in ESBL-KP strains than in non-ESBL-KP strains (p < 0.01). The ESBL-KP strains had different molecular patterns from non-ESBL-KP strains, based on pulsed-field gel electrophoresis. The frequency of serum-resistant isolates was the highest among ESBL-KP strains with rmpA (i.e., rmpA+) [71.4% (5/7)] than among of non-ESBL-KP rmpA+ strains [42.8% (6/14)], ESBL-KP strains without rmpA (rmpA−) [33.3% (7/21)], and non-ESBL-KP rmpA− strains [14.2% (2/14)]. The most significant increase in neutrophil resistance occurred in the ESBL-KP rmpA+ strains in comparison to the non-ESBL-KP rmpA+, ESBL-KP rmpA−, and non-ESBL-KP rmpA− strains (p < 0.01). The results of the animal survival model were compatible with the neutrophil phagocytosis reaction and serum bactericidal assay.ConclusionWe conclude that the pathogenic potential is greater in rmpA+ ESBL-KP strains than in rmpA– ESBL-KP and non-ESBL-KP strains

Boron Isotopic Analysis of Representative Atmospheric Aerosols Derived From Long-Range Transported/Local Emission on an Islet Offshore NE Taiwan

To identify pollutant origins and their potential sources from either long-range transported (LRT) or local emissions, the Boron (B) concentrations and the B isotopic compositions (δ11B) in the water-soluble fraction of aerosols were determined. These aerosols were collected from an islet offshore in northeastern Taiwan, Peng Chia Yu (PCY), a non-residential islet, from January 1998 to March 2000. This islet may be influenced by various pollutants or chemical transport during monsoon periods, but suffers minimal human perturbation locally. The B in the specimens falls to 0.3–1.63 ng m−3 during the SW monsoon seasons when compared to 0.46–2.56 ng m−3 in the NE monsoon. However, the δ11B results show no clear variations in both monsoon seasons (10.7–24.3‰), regardless of differences in air mass origin. A two end-member mixing scenario is proposed to explain our observations using the obtained δ11B and 1/[B] results. The ocean endmember is characterized by high 1/[B] and high δ11B; while other endmember is from continental endmember or anthropogenic contributions that are characterized by of 1/[B] and lowδ11B (δ11B &lt; 10‰). Based on these chemical and isotopic results, we found aerosol emissions in northern Taiwan are characterized as low B with nearly constant δ11B, when compared with long-range transported continental endmembers derived from nearby regions. This study provides preliminary B and δ11B levels in aerosols derived from LRT/local emissions and discusses potential monsoonal effects on aerosols offshore of NE Taiwan

Open lung biopsy in early-stage acute respiratory distress syndrome

INTRODUCTION: Acute respiratory distress syndrome (ARDS) has heterogeneous etiologies, rapid progressive change and a high mortality rate. To improve the outcome of ARDS, accurate diagnosis is essential to the application of effective early treatment. The present study investigated the clinical effects and safety of open lung biopsy (OLB) in patients with early-stage ARDS of suspected non-infectious origin. METHODS: We undertook a retrospective study of 41 patients with early-stage ARDS (defined as one week or less after intubation) who underwent OLB in two medical intensive care units of a tertiary care hospital from 1999 to 2005. Data analyzed included baseline characteristics, complication rate, pathological diagnoses, treatment alterations, and hospital survival. RESULTS: The age of patients was 55 ± 17 years (mean ± SD). The average ratio of arterial partial pressure of oxygen (PaO(2)) to fraction of inspired oxygen (FiO(2)) was 116 ± 43 mmHg (mean ± SD) at biopsy. Seventeen patients (41%) were immunocompromised. Postoperative complications occurred in 20% of patients (8/41). All biopsies provided a pathological diagnosis with a diagnostic yield of 100%. Specific pathological diagnoses were made for 44% of patients (18/41). Biopsy findings led to an alteration of treatment modality in 73% of patients (30/41). The treatment alteration rate was higher in patients with nonspecific diagnoses than in patients with specific diagnoses (p = 0.0024). Overall mortality was 50% (21/41) and was not influenced by age, gender, pre-OLB oxygenation, complication rate, pathological results, and alteration of treatment. There was no surgery-related mortality. The survival rate for immunocompromised patients was better than that for immunocompetent patients (71% versus 33%; p = 0.0187) in this study. CONCLUSION: Our retrospective study suggests that OLB was a useful and acceptably safe diagnostic procedure in some selected patients with early-stage ARDS

Neutralino Relic Density in a Supersymmetric U(1)' Model

We study properties of the lightest neutralino (\chi) and calculate its cosmological relic density in a supersymmetric U(1)' model with a secluded U(1)' breaking sector (the S-model). The lightest neutralino mass is smaller than in the minimal supersymmetric standard model; for instance, m_\chi < 100 GeV in the limit that the U(1)' gaugino mass is large compared to the electroweak scale. We find that the Z-\chi-\chi coupling can be enhanced due to the singlino components in the extended neutralino sector. Neutralino annihilation through the Z-resonance then reproduces the measured cold dark matter density over broad regions of the model parameter space.Comment: Version to be published in Physics Letters B. 13 pages, Revtex4, epsf.sty, 13 postscript figure