Dantrolene e células-tronco mesenquimais promovem melhora funcional em ratos Wistar com trauma espinhal agudo / Dantrolene and mesenchymal stem cells promote functional improvement in Wistar rats with spinal cord injury

Objetivou-se avaliar o efeito do dantrolene (DAN) e das células-tronco mesenquimais (CTM) no trauma espinhal agudo (TEA). Sessenta ratos Wistar foram divididos nos grupos CTM, DAN + CTM, DAN, trauma e placebo (TP) e sem trauma e placebo (STP). Realizou-se laminectomia de T12 em todos os grupos, seguida de TEA contusivo ∕ compressivo, com exceção do grupo STP. Uma hora depois, os grupos DAN + CTM e DAN receberam 10mg/kg de DAN. Após sete dias os grupos CTM e DAN + CTM receberam 1x106 células, por via intravenosa. Testes comportamentais foram realizados para avaliar a recuperação funcional durante 28 dias. Os animais traumatizados apresentaram paraplegia. Houve melhora funcional significativa nos grupos tratados com CTM, DAN ou associação DAN + CTM em comparação ao grupo TP (p<0,05). Conclui-se que o DAN e as CTM para tratamento de TEA em ratos apresentam efeitos neuroprotetores e promovem melhora neurológica funcional.(AU)

This study aimed to evaluate the effects of dantrolene (DAN) and mesenchymal stem cells (MSCs) in acute spinal cord injury (SCI). Sixty Wistar rats were divided into groups MSCs, MSCs + DAN, DAN, trauma and placebo (TP) and no trauma and placebo (STP). Laminectomy was performed at T12 level in all animals, followed by a weight-drop model of SCI, except for the STP group. An hour later, the MSCs + DAN and DAN groups received 10mg/kg of DAN. After seven days, the MSCs and MSCs + DAN groups received 1x106 cells intravenously. Behavioral tests were performed to assess functional recovery for 28 days. Traumatized animals showed paraplegia. There was a significant improvement in groups MSCs, DAN and MSCs + DAN compared to TP (p<0.05). It was concluded that DAN and MSCs for the treatment of SCI in rats have neuroprotection effect and promote functional neurological improvement.(AU)

The Effect of Prolonged Inpatient Rehabilitation Therapy in Subacute Stroke Patients

OBJECTIVE: To evaluate the effect of prolonged inpatient rehabilitation therapy in subacute stroke patients. METHOD: We enrolled 52 subacute stroke patients who had received 3 months of inpatient rehabilitation therapy. Thirty stroke patients received additional inpatient rehabilitation therapy for 3 months and 22 control patients received only home-based care. The evaluation was measured at 3 and at 6 months after stroke occurrence. Functional improvement was measured using the modified motor assessment scale (MMAS), the timed up and go test (TUG), the 10-meter walking time (10 mWT), the Berg balance scale (BBS) and the Korean-modified Barthel index (K-MBI). The health-related quality of life was evaluated using the medical outcome study, 36-item short form survey (SF-36). RESULTS: In the experimental group, significant improvements were observed for all parameters at 6 months (p<0.05). However, significant improvements were observed only in MMAS, BBS, and K-MBI at 6 months in the Control group (p<0.05). In comparing the 2 groups, significant difference were observed in all parameters (p<0.05) except 10 meter walking time (p=0.73). The improvement in SF-36 was meaningfully higher in experimental group compared to control group. CONCLUSION: This study demonstrates that subacute stroke patients can achieve functional improvements and an enhanced quality of life through prolonged inpatient rehabilitation therapy.

The Impact of Fentanyl Matrix on Pain and Function in Spinal Disorder-Related Chronic Pain: An Open Label Trial in Korea

STUDY DESIGN: This is a multicenter, open-label prospective, non interventional study. PURPOSE: We wanted to evaluate the impact of fentanyl matrix on the pain and function of patients with spinal disorder-related chronic, non-malignant pain. OVERVIEW OF LITERATURE: Patients with severe non-malignant chronic low back pain may require opioid analgesics for effective pain management. METHODS: A total of 1,576 patients with severe pain (numeric rating scale = 7) were evaluated for their pain intensity at the initial visit and at weeks 4 and 8 (Visits 1, 2, and 3, respectively). Disturbances in sleep, daily living and social activities, the Oswestry Disability Index (ODI), the researchers' and patients' global assessment and the patients' treatment preference were also assessed. RESULTS: The pain intensity score significantly decreased from 8.1 at Visit 1 to 5.4 and 4.4 at Visits 2 and 3, respectively. Sleep disturbance also significantly decreased and the extent of disturbance of daily and social activities was also significantly improved. The ODI significantly decreased from 61.9% to 45.8% and 38.2% at Visits 1, 2, and 3, respectively. Adverse events were reported by 197 (12.5%) patients and severe adverse events were reported by 12 (0.76%) patients. Overall, 76.3% of the patients and 78.4% of the investigators rated the test drug as effective. CONCLUSIONS: The fentanyl matrix is believed to be effective for the treatment of pain, sleep disturbance and the impact upon daily and social activities, yet physicians should pay attention to the risks of abuse and the adverse events.

Surgical myocardial revascularization of patients with ischemic cardiomyopathy and severe left ventricular disfunction

Objective: To determine long-term survival, identify preoperative factors predictive of a favorable outcome, and assess functional improvement after coronary artery bypass grafting in patients with advanced left ventricular dysfunction. Methods: Between 1995 and 2001, 244 patients who underwent coronary artery bypass grafting and had a preoperative left ventricular ejection fraction less than or equal to 35 percent were included. left ventricular ejection fraction was determined by uniplanar or biplanar ventriculography during left heart catheterization. Indication for surgery was predominance of tissue viability. Functional improvement was evaluated through echocardiography and gated scintigraphy at exercise/ rest. Survival was determined by Kaplan-Meier analysis. Results: Mean left ventricular ejection fraction was 29±4 percent (ranged from 9 percent to 35 percent). An average of 3.01 coronary bypass grafts per patient were performed. In-hospital mortality was 3.7 percent (9 patients). The 4-year survival rate was 89.7 percent. Multivariate correlates of favorable short- and long-term outcome were preoperative New York Heart Association Funcional classification for congestive heart failure class I/II, lower PAsP, higher left ventricular ejection fraction and gated left ventricular ejection fraction Ex/Rest ratio >5 percent. Left ventricular ejection fraction rise from 32±5 percent to 39±5 percent, p <0.001. Gated left ventricular ejection fraction at exercise/ rest increased markedly after surgery: from 27±8 percent/ 23±7 percent to 37±5 percent/ 31±6 percent, p <0.001. Conclusions: In selected patients with severe ischemic left ventricular dysfunction and predominance of tissue viability, coronary artery bypass grafting may be capable of implement preoperative clinical/ functional parameters in predicting outcome as left ventricular ejection fraction and gated left ventricular ejection fraction at exercise/ rest.

The Effectiveness of Pulmonary Rehabilitation Program on Functional Improvement in Patients with Spinal Cord Injury

OBJECTIVE: To investigate the effectiveness of pulmonary rehabilitation program on functional improvement in patients with spinal cord injury and the difference between tetraplegics and paraplegics. METHOD: Twenty one patients without previous history of pulmonary pathology were recruited for this study. Fourteen patients were tetraplegic (12 males, 2 female; mean duration of disease, 42.2+/-7.9 days; mean age, 52.7+/-3.4 years old), seven patients were paraplegic (6 males, 1 female; mean duration of disease, 48.8+/-6.3 days; mean age, 42.1+/-3.7 years old). All patients received pulmonary rehabilitation composed of respiratory muscles strengthening exercise, positive inflation exercise, and breathing exercise with Breather(R) for 30 minutes a session, twice a day, five days per week for 4 weeks. We evaluated arterial blood gas analysis, pulmonary function test (PFT), modified Borg scale (MBS), Spinal Cord Independence Measure (SCIM), and Functional Independence Measure (FIM) as outcome measures at the beginning and 4 weeks after treatment. RESULTS: After the pulmonary rehabilitation program, both of PaO2 and SaO2 increased in tetraplegia and paraplegia groups. MBS improved at rest and on exercise in both of paraplegia and tetraplegia groups (p<0.05). FEV1 and FVC increased in both groups (p<0.05). Both SCIM and FIM scores increased in both groups (p<0.05). The difference of the improvement ratio of PFT, MBS and functional scales between tetraplegia and paraplegia groups was not significant. CONCLUSION: It is suggested that pulmonary rehabilitation program would be useful to improve the functional improvement including of pulmonary function and subjective dyspnea scale in both of tetraplegia and paraplegia groups.

Factors associated with functional improvement at discharge in stroke rehabilitation.

Objective: To study the factors associated with the functional improvement at discharge in stroke patients receiving inpatient rehabilitation. Methods: Retrospective review of the medical records of all the stroke patients admitted to inpatient rehabilitation, Department of Rehabilitation Medicine, Siriraj Hospital from January 2005 to December 2005. Results: There were sixty-one stroke patients, 39 males and 22 females, with a mean age 62.5 years old. Most of them lived with their spouses (61%) and had cerebral infarction (61%). The risk factors of stroke reported were hypertension (86.9%), dyslipidemia (63.9%), diabetes mellitus (34.4%), previous stroke (31.1%), heart disease (18%), smoking (8.2%) and regular alcoholic drinking (3.3%) respectively. The right and left side weakness were equally reported. The median duration of stroke before admission was 62 days. The disabilities at admission were urinary incontinence (39.3%), dysphagia (32.8%), and aphasia (26.2%). During the hospital stay, the complications which occurred were shoulder problems (41%), other musculoskeletal pain (34.4%), depression (26.2%), shoulder hand syndrome (13.1%), urinary tract infection (6.6%), and pneumonia (4.9%) respectively. Forty-seven patients (77%) gained functional improvement at discharge. The Chi-Square and Independent Sample T tests revealed the association between the functional improvement at discharge and urinary continence on admission (p=0.011), and duration of stroke within 3 months before admission to rehabilitation (p=0.011) with the odds ratio 5.9 and 5.3 respectively. Conclusions: The functional improvement after the process of inpatient stroke rehabilitation was associated with the duration of stroke within 3 months before rehabilitation admission and urinary continence on admission.

Functional Status and Blood Level of IGF-1 and IGFBP-3 in Post-acute Stage Brain Diseases

OBJECTIVE: To evaluate the blood level of IGF-1 (insulin-like growth factor-1) and IGFBP-3 (insulin-like growth factor binding protein-3) in patients with post-acute stage brain diseases, and to investigate the relationship between IGF-1/ IGFBP-3 blood level and functional status in patients with post-acute stage brain diseases. METHOD: Initial IGF-1/IGFBP-3 blood levels of 32 patients with post-acute stage brain disease were obtained and various functional indices, including modified Barthel index (MBI), functional ambulatory category (FAC), and Jebsen hand function test (JHFT), were assessed initially and at discharge. RESULTS: The IGF-1 blood level was normal in 23 patients and decreased in 9. The IGFBP-3 blood level was normal in 20 patients and increased in 13. The initial IGF-1/IGFBP- 3 levels were associated with the change of MBI score during admission (p<0.05, r2=0.214/p<0.05, r2=0.213). There was a correlation between IGF-1/IGFBP-3 levels and JHFT score only on the unaffected side at discharge (p<0.05, r2=0.278). There was no relation between IGF-1/IGFBP-3 levels and the change of JHFT score on either side during admission. CONCLUSION: Initial IGF-1/IGFBP-3 blood level check can be a useful method to anticipate functional improvement of patients with post-acute stage brain disease.

Functional Improvement of the Patients with Inpatient Rehabilitation after Total Hip Replacement

OBJECTIVE: To determine the functional outcomes of the patients with total hip replacement and to evaluate the variables associated with the functional recovery. METHOD: Subjects were 188 patients, who had undertaken total hip replacement between March 1, 1997 and July 31, 1999 at Asan Medial Center. The four functional milestones including sitting, standing, 50 m walking, and climbing stairs were evaluated. RESULTS: The average duration of treatment was 8.3 +/- 7.0 days, and the days required for sitting were 1.9 +/- 1.0; standing 2.4 +/- 1.8; walking 50 m 6.4 +/- 4.3; climbing stairs 7.9 +/- 4.5 days. In results of analysis of each variable, male patients showed faster functional improvement than female patients in standing and climbing stairs. The patients of age 60 years and over had slower recovery in sitting and standing. The patients with sequelae of septic hip or Legg-Calve-Perthes disease had slower recovery than the others in standing. The patient with the use of cement showed rapid improvement in sitting and standing. Those who could bear full weight had rapid recovery than those with partial weight. CONCLUSION: We would like to suggest that careful consideration on characteristics of each patient should be given in determining the duration of rehabilitation management of the patients who had total hip replacement.