The rehabilitation of motor and cognitive disorders after stroke

Following a stroke there can be a large range of different deficits, with poor motor function and cognition being particularly important for outcome. Rehabilitation of these deficits is thus an important priority for clinicians. In this thesis, I present 5 experimental chapters aiming to generate cognitive and motor benefits for the stroke survivor. In Chapter 2, prolonged Mirror Therapy was applied to chronic stroke survivors. In Chapter 3, Mirror Therapy was applied in a home based for chronic stroke survivors. In both these Chapters 2 and 3 benefits in unimanual performance of the affected limb and functional improvements of daily activities are being reported. Chapter 4 considered the application of Mirror Therapy to early subacute stroke participants and tested the neural correlates behind any effect. Changes in brain activation within both the ipsi- and contralesional hemispheres were noted. Functional Electrical Stimulation was applied to chronic stroke patients in Chapter 5. Improvements in motor performance were noted, along with the amelioration of visuomotor neglect. Linked changes in activity in the ipsi- and contralesional hemispheres were again noted. Finally, in Chapter 6, Computer Progressive Attention Training was applied in early subacute stroke patients, comparing performance with patients who received no extra intervention. Importantly, the training not only improved the tested functions but also other cognitive processes not targeted in training (e.g., long-term memory). Taken together, the experimental work provides evidence of strategies that can be followed by clinicians to improve functional ability after stroke. In the final chapter the above findings are being discussed together with clinical implications of motor and cognitive rehabilitation approaches

The role of the biodegradable and hemostatic gauze to the sealing of the perforated bowel and its regeneration

In this study, 40 laboratory animals (wistar type rats) were used in total. The rats were divided in two groups, A and B, of 20 each. Their average age was about 12 weeks old.All of the laboratory animals underwent middle incision laparotomy under general anesthesia.Before the surgical procedure, Zinacef 750mg was administered at a dose of 20mg/rat (per 350gr weight). After the procedure, the middle incision was closed using continuous absorbable sutures.Those of the laboratory animals that survived were euthanized due to EU regulations. Our study shows that the use of Tachosil is efficient with regards to the sealing of the perforated small bowel and its regeneration.Στην παρούσα ερευνητική μελέτη χρησιμοποιήθηκαν συνολικά40 πειραματόζωα (αρουραίοι) τύπου wistar. Οι αρουραίοι χωρίστηκαν σε δύο ομάδες Α και Β από 20 σε αριθμό. Ο μέσος όρος της ηλικίας τους ήταν περίπου 12 εβδομάδες.Όλα τα πειραματόζωα υποβλήθηκαν σε λαπαροτομία με τη βοήθεια μέσης χειρουργικής τομής και αναισθητοποιήθηκαν με γενική αναισθησία.Πριν από την χειρουργική επέμβαση χορηγήθηκε αντιβίωση zinocef 750mg με δόση 20mg/rat για 350gr σωματικού βάρους. Μετά την χειρουργική επέμβαση έγινε σύγκλειση της μέσης τομής με συνεχές απορροφήσιμο ράμμα.Όσα πειραματόζωα επιβίωσαν υποβάλλονται σε ευθανασία σύμφωνα με τις οδηγίες της Ευρωπαϊκής Ένωσης και η έρευνα απέδειξε ότι η χρήση του Tachosil ήταν αποτελεσματική όσο αφορά την στεγανοποίηση της οπής του λεπτού εντέρου και της αναγεννητικής ικανότητας προς επούλωση

Cervical lymph node dissection in papillary thyroid cancer: Current trends, persisting controversies, and unclarified uncertainties

Cervical lymph node metastases are very common in patients with papillary thyroid cancer (PTC). Despite that PTC has an excellent prognosis, lymphatic spread is associated with increased risk of loco-regional recurrence, which significantly impairs quality-of-life and can alter prognosis of the patient. Therefore, the identification of lymph node metastases preoperatively is very important for the surgeon to plan the optimal surgical therapy for the individual patient. In most western countries, cervical lymph node dissection (CLND) is performed in the presence of cervical lymphadenopathy (therapeutic CLND). In contrast, in eastern countries (mainly in Japan, where the use of postoperative radioiodine adjuvant therapy is restricted by law), most surgeons perform prophylactic CLND (i.e., CLND in the absence of cervical lymphadenopathy). CLND is performed on a compartment-oriented basis. Currently, given the very high incidence of cervical lymph node metastases in PTC, there is a clear trend even in western countries in favor of central (level IV) node dissection, even in patients without clinically or ultrasonographically evident node disease. This surgical strategy will prevent disease recurrence, which may require an additional and more morbid surgery. Experience is therefore required from the part of the operating surgeon, who should be able to perform safely CLND at the time of initial surgery (thyroidectomy), to minimize surgical morbidity. (C) 2009 Published by Elsevier Ltd

Motor Development and Motor Resonance Difficulties in Autism: Relevance to Early Intervention for Language and Communication Skills

Research suggests that a sub-set of children with autism experience notable difficulties and delays in motor skills development, and that a large percentage of children with autism experience deficits in motor resonance. These motor-related deficiencies, which evidence suggests are present from a very early age, are likely to negatively affect social-communicative and language development in this population. Here, we review evidence for delayed, impaired, and atypical motor development in infants and children with autism. We then carefully review and examine the current language and communication-based intervention research that is relevant to motor and motor resonance (i.e., neural mirroring mechanisms activated when we observe the actions of others) deficits in children with autism. Finally, we describe research needs and future directions and developments for early interventions aimed at addressing the speech/language and social-communication development difficulties in autism from a motor-related perspective

Conservative treatment of acute appendicitis: heresy or an effective and acceptable alternative to surgery?

For more than a century, emergency appendectomy has been a ‘surgical dogma’ in the management of acute appendicitis (AA). During recent decades, however, there is an increasing body of evidence suggesting that selected patients with AA could be treated conservatively. This approach has many advantages, including high success and low recurrence rates, reduced morbidity and mortality, less pain, shorter hospitalization and sick leave, and reduced costs. Despite that conservative management of AA cannot be used for all patients with AA (for example, in the presence of peritonitis), it could be preferred in a large percentage of patients with mild infection (as evidenced by clinical, laboratory, and imaging findings). Eur J Gastroenterol Hepatol 23:121-127 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

A Greek registry of current type 2 diabetes management, aiming to determine core clinical approaches, patterns and strategies

Background: To analyze data in terms of the glycaemic control and therapeutic regimens used for Type-2 Diabetes Mellitus (T2DM) management in Greece, identify factors that influence clinical decisions and determine the level of compliance of T2DM management with the latest international and local guidelines. Methods: 'AGREEMENT' was a national-multicenter, non-interventional, cross-sectional disease registry. A total of 1191 adult T2DM patients were enrolled consecutively from 59 sites of the National Health System (NHS) or University Hospitals, representing the majority of Diabetes centers or Diabetes outpatient clinics in Greece with a broad geographic distribution. Patients were stratified by gender and analysis was done according to 3 treatment strategies: A (lifestyle changes or use of one oral antidiabetic agent), B (up to 3 antidiabetic agents including injectables but not insulin) and C (any regimens with insulin). Results: Mean (±SD) HbA1c % of the total population was 7.1 (±1.2) while mean (±SD) FPG (mg/dl) was measured at 136 (±42). The proportion of patients who achieved HbA1c < 7% was 53% and ranged from 74.2% for group A, to 60.6% for group B and 35.5% for group C. Median age of the studied population was 65.0 year old (Interquartile Range-IQR 14.0) with an equal distribution of genders between groups. Patients on insulin therapy (treatment strategy C) were older (median age: 67 years vs 63 or 65 for A and B, respectively) with longer diabetes duration (mean duration: 15.3 years vs 5.2 and 10.1 for A and B, respectively). Patients who received insulin presented poor compliance. There was a consensus for a series of decision criteria and factors that potentially influence clinical decisions, used by physicians for selection of the therapeutic strategy among the three groups. Compliance with international and Greek guidelines received a high score among groups A, B and C. No significant differences were presented as per sites' geographic areas, NHS or University centers and physicians' specialty (endocrinologists, diabetologists and internists). Conclusions: The presented findings suggest the need for improvement of the glycaemic control rate, especially among insulin treated patients as this group seems to achieve low glycaemic control, by setting appropriate HbA1c targets along with timely and individualised intensification of treatment as well as post-therapy evaluation of the compliance with the proposed treatment. © 2019 The Author(s)