A nearly full-recovery from AVM hemorrhagic stroke 17 years after insult using a new integrated neurodevelopmental approach: A case report.

RATIONAL: With the prevalence of stroke increasing in the USA and the world along with increased survival and longevity due to medical advancements, it has become increasingly necessary to look at the chronic phase of stroke recovery. Previous paradigms of stroke treatment have proven ineffective when looking at 10, 15, or 20 years of survival post insult. PATIENT CONCERNS: The patient, being a young man just out of high school, was concerned with his overall morbidity. He was highly concerned with the quality of life he could expect as a stroke survivor with a life expectancy of 60 years or more. DIAGNOSES: C was diagnosed with a hemorrhagic AVM stroke that impacted several regions of the brain, particularly the right occipital and temporal lobes as well as bilateral motor control. C experienced severe hpertonicity of the musculature and significant vertigo. INTERVENTIONS: This study investigated a novel approach to chronic-phase stroke rehabilitation using traditional child motor-learning techniques, play, and proprioceptive-building activities in addition to current stroke rehabilitation techniques. During an initial six-month period, followed by a three-year period, the participant used motor-developmental learning activities as well as traditional strength, gait, and balance training. During the initial phase of treatment, clinically-significant improvements were recorded along with self-reported lifestyle enhancements. These gains continued throughout the three-and-a-half year process. OUTCOMES: C regained the ability to free-walk in small bouts and went from the use of a walker to canes. He regained use of his hands and removed a large partion of his vertigo. Of specific interest was the participant's ability to progress from using a walker to driving, returning to school, and starting a family. LESSONS: This study lays the groundwork for future studies into this type of therapeutic approach as well as highlighting the ability of chronic-phase stroke patients to recover well into the second decade post stroke. After the initial six month period, as gains were being observed, a more formal measurement process was begun for a second six-month period. Initial measurements of progress were taken every six weeks using the Fugl-Meyer test, the Berg Balance Test, the Barthel Index, and the Stroke Specific Quality Of Life scale. Results showed clinically significant improvements in all areas of recovery.

Using Movies to Strengthen Learning of the Humanistic Aspects of Medicine.

INTRODUCTION: Movie screening and activities have been used during the last two semesters (spring and summer 2015) to strengthen the learning of communication skills, empathy, professionalism, and greater understanding of the process and death and dying at the Xavier University School of Medicine. AIM: The present manuscript describes the movie screening and activities. Student feedback regarding the sessions is also mentioned. SETTINGS AND DESIGN: The activity was conducted among basic science undergraduate medical students and student feedback was obtained. A cross-sectional study design was used. MATERIALS AND METHODS: Feedback was obtained towards the end of June 2015 using a questionnaire designed by the authors. Participants were asked to rate their degree of agreement with the set of statements and provide an overall rating for the sessions. No demographic information was collected. STATISTICAL ANALYSIS: Cronbach's alpha was calculated as a measure of internal consistency. The normality of distribution of the scores of individual statements and of the overall rating was determined using one sample Kolmogorov-Smirnov test. The average scores were calculated. Free text comments were tabulated. RESULTS: Forty-nine of the 63 students (77.8%) participated in the study. Cronbach's alpha was 0.868 indicating a high level of internal consistency. The median scores indicating the degree of agreement with most statements ranged from 3 to 5. The mean participant rating of the sessions was 7.10 (maximum possible score 10). A few participants provided free text comments regarding the sessions. CONCLUSION: Student feedback about the session was positive. Impact of the session on humanistic issues, professionalism and death and dying should be studied in future.

Long-term effects of calorie restriction on serum sex-hormone concentrations in men.

Calorie restriction (CR) slows aging and consistently reduces circulating sex hormones in laboratory animals. However, nothing is known regarding the long-term effects of CR with adequate nutrition on serum sex-hormone concentration in lean healthy humans. In this study, we measured body composition, and serum total testosterone, total 17-beta-estradiol, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEA-S) concentrations in 24 men (mean age 51.5 +/- 13 years), who had been practicing CR with adequate nutrition for an average of 7.4 +/- 4.5 years, in 24 age- and body fat-matched endurance runners (EX), and 24 age-matched sedentary controls eating Western diets (WD). We found that both the CR and EX volunteers had significantly lower body fat than the WD volunteers (total body fat, 8.7 +/- 4.2%; 10.5 +/- 4.4%; 23.2 +/- 6.1%, respectively; P = 0.0001). Serum total testosterone and the free androgen index were significantly lower, and SHBG was higher in the CR group than in the EX and WD groups (P < or = 0.001). Serum 17beta-estradiol and the estradiol:SHBG ratio were both significantly lower in the CR and EX groups than in the WD group (P < or = 0.005). Serum DHEA-S concentrations were not different between the three groups. These findings demonstrate that, as in long-lived CR rodents, long-term severe CR reduces serum total and free testosterone and increases SHBG concentrations in humans, independently of adiposity. More studies are needed to understand the role of this CR-mediated reduction in sex hormones in modulating the pathogenesis of age-associated chronic diseases such as cancer and the aging process itself.