Low Phase Angle and Skeletal Muscle Index Increase Hospital-Acquired Infections During Stroke Rehabilitation.

OBJECTIVES: Sarcopenia is common in patients with stroke and may increase the risk of medical complications such as infection. However, assessing sarcopenia in stroke patients with consciousness disturbance, aphasia or severe paralysis is challenging. This study aimed to investigate whether a combined assessment of phase angle (PhA) and skeletal muscle index (SMI), estimated using bioelectrical impedance analysis, was associated with 2 common nosocomial infections, hospital-acquired pneumonia (HAP) and urinary tract infection (UTI), during inpatient stroke rehabilitation. DESIGN: Single-center retrospective observational study. SETTINGS AND PARTICIPANTS: A total of 1068 patients with stroke admitted to a rehabilitation hospital between January 2016 and September 2019 were analyzed. METHODS: The study variables included demographic characteristics, comorbidities, stroke severity, blood chemistry and urine analysis, SMI, and PhA obtained using bioelectrical impedance analysis. Patients were classified as normal, low PhA only, low SMI only, and low PhA + SMI. Multivariate Cox proportional analysis was used to determine the variables associated with HAP and UTI. RESULTS: A combination of low PhA + SMI was observed in 429 (40.2%) patients. Over a median follow-up duration of 46 days, HAP occurred in 187 patients (17.5%) and UTI occurred in 155 patients (14.5%). The low PhA + SMI group showed a significantly higher incidence of HAP and UTI than the normal group (32.6% vs 4.6%, P < .001, for HAP; 20.7% vs 6.2%, P < .001, for UTI). In multivariate Cox analyses, low PhA and SMI were associated with significantly higher rates of HAP [hazard ratio (HR) 3.36, 95% CI 1.796-6.304, P < .001] and UTI (HR 1.71, 95% CI 1.002-2.947, P < .05) after adjusting for confounding variables. CONCLUSIONS AND IMPLICATIONS: Combination of low PhA + SMI was independently associated with a higher risk of HAP and UTI in stroke patients who underwent inpatient rehabilitation. Measuring PhA and SMI using bioelectrical impedance analysis might be helpful in establishing care plans in these population.

Reliability of the Modified Ashworth and Modified Tardieu Scales with Standardized Movement Speeds in Children with Spastic Cerebral Palsy.

The Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) are widely used to quantify spasticity. However, the reliability of their use for ankle plantar flexors has been questioned. In this study, we aimed to examine whether their reliabilities could be increased to acceptable levels for ankle plantar flexors using standardized movement speed in children with spastic cerebral palsy. The MAS and MTS scores for 92 limbs were assessed by two raters on two occasions, 1 week apart. A metronome was used to maintain the stretching velocity at 120 beats per minute. The intraclass correlation coefficients (ICCs) of the intra-rater reliabilities of the MAS and MTS and inter-rater reliability of the MAS were over 0.7. However, the ICCs for the inter-rater reliability of the MTS were <0.7 and >0.75 for the gastrocnemius and soleus muscles, respectively. The ICCs for the inter- and intra-rater reliabilities of the R1 angles ranged from 0.68 to 0.84, while those of the R2 angles ranged from 0.74 to 0.93. The reliabilities of the R2-R1 angles were not satisfactory. In conclusion, with a standardized movement speed, the reliability of the MAS for the ankle plantar flexors and the MTS for the soleus were satisfactory; however, that of the MTS for the gastrocnemius was not.

The Effects of Over-Ground Robot-Assisted Gait Training for Children with Ataxic Cerebral Palsy: A Case Report.

Poor balance and ataxic gait are major impediments to independent living in ataxic cerebral palsy (CP). Robot assisted-gait training (RAGT) has been shown to improve the postural balance and gait function in children with CP. However, there is no report on the application of RAGT for children with ataxic CP. Here, we report two cases of children with ataxic CP who underwent over-ground RAGT along with conventional therapy for 4 weeks. Outcome measures including the gross motor function measure (GMFM), pediatric balance scale, pediatric reach scale, one-minute walk test, and Timed Up and Go test were assessed before and after the 4-week intervention. Both cases were well adapted to the RAGT system without any significant adverse event. Improvements in the GMFM after RAGT, compared with that in the GMFM, after intensive conventional therapy have been reported previously. It is noteworthy that over-ground RAGT improved areas of the GMFM that did not improve with conventional therapy. In addition, over-ground RAGT with conventional therapy led to improvements in functional balance and walking capacity. These findings suggest that over-ground RAGT is feasible and may be a potential option for enhancing balance and functional walking capacity in children with ataxic CP.

Characterization of hazardous and odorous volatiles emitted from scented candles before lighting and when lit.

Scented candles are known to release various volatile organic compounds (VOCs) including both pleasant aromas and toxic components both before lighting (off) and when lit (on). In this study, we explored the compositional changes of volatiles from scented candles under various settings to simulate indoor use. Carbonyl compounds and other VOCs emitted from six different candle types were analyzed under 'on/off' conditions. The six candle types investigated were: (1) Clean cotton (CT), (2) Floral (FL), (3) Kiwi melon (KW), (4) Strawberry (SB), (5) Vanilla (VN), and (6) Plain (PL). Although a large number of chemicals were released both before lighting and when lit, their profiles were noticeably distinguishable. Before lighting, various esters (n = 30) showed the most dominant emissions. When lit, formaldehyde was found to have the highest emission concentration of 2098 ppb (SB), 1022 ppb (CT), and 925 ppb (PL). In most lit scented candles, there was a general tendency to show increased concentrations of low boiling point compounds. For some scented candle products, the emission of volatiles occurred strongly both before lighting and when lit. For instance, in terms of TVOC (ppbC), the highest concentrations were observed from the KW product with their values of 12,742 (on) and 2766 ppbC (off). As such, the results suggest that certain scented candle products should act as potent sources of VOC emission in indoor environment, regardless of conditions--whether being lit or not.

Odor and VOC emissions from pan frying of mackerel at three stages: raw, well-done, and charred.

Many classes of odorants and volatile organic compounds that are deleterious to our wellbeing can be emitted from diverse cooking activities. Once emitted, they can persist in our living space for varying durations. In this study, various volatile organic compounds released prior to and during the pan frying of fish (mackerel) were analyzed at three different cooking stages (stage 1 = raw (R), stage 2 = well-done (W), and stage 3 = overcooked/charred (O)). Generally, most volatile organic compounds recorded their highest concentration levels at stage 3 (O), e.g., 465 (trimethylamine) and 106 ppb (acetic acid). In contrast, at stage 2 (W), the lowest volatile organic compounds emissions were observed. The overall results of this study confirm that trimethylamine is identified as the strongest odorous compound, especially prior to cooking (stage 1 (R)) and during overcooking leading to charring (stage 3 (O)). As there is a paucity of research effort to measure odor intensities from pan frying of mackerel, this study will provide valuable information regarding the management of indoor air quality.

Monoterpenes released from fruit, plant, and vegetable systems.

To quantify the emission rate of monoterpenes (MTs) from diverse natural sources, the sorbent tube (ST)-thermal desorption (TD) method was employed to conduct the collection and subsequent detection of MTs by gas chromatography. The calibration of MTs, when made by both mass spectrometric (MS) and flame ionization detector (FID), consistently exhibited high coefficient of determination values (R2 > 0.99). This approach was employed to measure their emission rate from different fruit/plant/vegetable (F/P/V) samples with the aid of an impinger-based dynamic headspace sampling system. The results obtained from 10 samples (consisting of carrot, pine needle (P. sylvestris), tangerine, tangerine peel, strawberry, sepals of strawberry, plum, apple, apple peel, and orange juice) marked α-pinene, ß-pinene, myrcene, α-terpinene, R-limonene, γ-terpinene, and p-cymene as the most common MTs. R-limonene was the major species emitted from citrus fruits and beverages with its abundance exceeding 90%. In contrast, α-pinene was the most abundant MT (37%) for carrot, while it was myrcene (31%) for pine needle. The overall results for F/P/V samples confirmed α-pinene, ß-pinene, myrcene, α-terpinene, and γ-terpinene as common MTs. Nonetheless, the types and magnitude of MTs released from fruits were distinguished from those of vegetables and plants.

The reproducibility of indoor air pollution (IAP) measurement: a test case for the measurement of key air pollutants from the pan frying of fish samples.

To assess the robustness of various indoor air quality (IAQ) indices, we explored the possible role of reproducibility-induced variability in the measurements of different pollutants under similar sampling and emissions conditions. Polluted indoor conditions were generated by pan frying fish samples in a closed room. A total of 11 experiments were carried out to measure a list of key variables commonly used to represent indoor air pollution (IAP) indicators such as particulate matter (PM: PM1, PM2.5, PM10, and TSP) and a set of individual volatile organic compounds (VOCs) with some odor markers. The cooking activity conducted as part of our experiments was successful to consistently generate significant pollution levels (mean PM10: 7110 µg m(-3) and mean total VOC (TVOC): 1400 µg m(-3), resp.). Then, relative standard error (RSE) was computed to assess the reproducibility between different IAP paramters measured across the repeated experiments. If the results were evaluated by an arbitrary criterion of 10%, the patterns were divided into two data groups (e.g., <10% for benzene and some aldehydes and >10% for the remainders). Most noticeably, TVOC had the most repeatable results with a reproducibility (RSE) value of 3.2% (n = 11).