Clinical value of assessing motor performance in postacute stroke patients.

BACKGROUND: Rehabilitative treatment plans after stroke are based on clinical examinations of functional capacity and patient-reported outcomes. Objective information about daily life performance is usually not available, but it may improve therapy personalization. OBJECTIVE: To show that sensor-derived information about daily life performance is clinically valuable for counseling and the planning of rehabilitation programs for individual stroke patients who live at home. Performance information is clinically valuable if it can be used as a decision aid for the therapeutic management or counseling of individual patients. METHODS: This was an observational, cross-sectional case series including 15 ambulatory stroke patients. Motor performance in daily life was assessed with body-worn inertial sensors attached to the wrists, shanks and trunk that estimated basic physical activity and various measures of walking and arm activity in daily life. Stroke severity, motor function and activity, and degree of independence were quantified clinically by standard assessments and patient-reported outcomes. Motor performance was recorded for an average of 5.03 ± 1.1 h on the same day as the clinical assessment. The clinical value of performance information is explored in a narrative style by considering individual patient performance and capacity information. RESULTS: The patients were aged 59.9 ± 9.8 years (mean ± SD), were 6.5 ± 7.2 years post stroke, and had a National Institutes of Health Stroke Score of 4.0 ± 2.6. Capacity and performance measures showed high variability. There were substantial discrepancies between performance and capacity measures in some patients. CONCLUSIONS: This case series shows that information about motor performance in daily life can be valuable for tailoring rehabilitative therapy plans and counseling according to the needs of individual stroke patients. Although the short recording time (average of 5.03 h) limited the scope of the conclusions, this study highlights the usefulness of objective measures of daily life performance for the planning of rehabilitative therapies. Further research is required to investigate whether information about performance in daily life leads to improved rehabilitative therapy results.

Suitability of commercial barometric pressure sensors to distinguish sitting and standing activities for wearable monitoring.

Despite its medical relevance, accurate recognition of sedentary (sitting and lying) and dynamic activities (e.g. standing and walking) remains challenging using a single wearable device. Currently, trunk-worn wearable systems can differentiate sitting from standing with moderate success, as activity classifiers often rely on inertial signals at the transition period (e.g. from sitting to standing) which contains limited information. Discriminating sitting from standing thus requires additional sources of information such as elevation change. The aim of this study is to demonstrate the suitability of barometric pressure, providing an absolute estimate of elevation, for evaluating sitting and standing periods during daily activities. Three sensors were evaluated in both calm laboratory conditions and a pilot study involving seven healthy subjects performing 322 sitting and standing transitions, both indoor and outdoor, in real-world conditions. The MS5611-BA01 barometric pressure sensor (Measurement Specialties, USA) demonstrated superior performance to counterparts. It discriminates actual sitting and standing transitions from stationary postures with 99.5% accuracy and is also capable to completely dissociate Sit-to-Stand from Stand-to-Sit transitions.

Time- and dose-related effects of three 5-HT receptor ligands on the genioglossus activity in anesthetized and conscious rats.

Clinical trials in obstructive sleep apnea syndrome patients reported moderate effects of serotoninergic drugs on oropharyngeal apneas, although numerous specific 5-HT ligands highly modulate the genioglossus muscle (GG) activity in experiments performed in anesthetized animals. The purpose of this study was to investigate time- and dose-related effects of central and systemic injections of 8-OHDPAT (5-HT1A agonist), SB224289 (5-HT1B antagonist), and DOI (5-HT2A/2C agonist) on the GG activity in anesthetized and conscious rats. Electromyographic recordings of the GG activity (GGemg) were analyzed after central and systemic injections of each drug in ketamine-xylazine anesthetized rats. Electroencephalograms (EEG), as well as neck and GG muscle activities (Nemg and GGemg), were recorded in 15 additional rats to analyze changes in sleep-wake states before and after systemic injection of the drugs. Central injections of 8-OHDPAT and DOI in anesthetized rats induced clear dose-related increases in phasic and tonic GGemg activities, respectively. The time-responses were inferior to 30 min with 8-OHDPAT and over 50 min with DOI. Moderate increases in phasic GGemg activity were also observed after central, but not peripheral injection of SB and DOI. The total sleep time measured in conscious rats significantly decreased after systemic injections of DOI and 8-OHDPAT, although no change was observed in phasic or tonic GGemg activity. The dose- and time-responses of the DOI in anesthetized rat partly explain the lack of GGemg tonic change in conscious rat. The moderate effect on the GGemg phasic activity of peripheral 5-HT1A ligand injection easily explains the lack of change in conscious rat. The serotonergic modulation of the respiratory component of the GGemg remains complex, but is highly sensitive to 5-HT1A receptors after central injection in rats under anesthesia. Forthcoming therapy in OSAS should be made of mixed profiled neurotransmitters and different routes of administration.

Shielding evaluation of a medical linear accelerator vault in preparation for installing a high-dose rate 252Cf remote afterloader.

In support of the effort to begin high-dose rate 252Cf brachytherapy treatments at Tufts-New England Medical Center, the shielding capabilities of a clinical accelerator vault against the neutron and photon emissions from a 1.124 mg 252Cf source were examined. Outside the clinical accelerator vault, the fast neutron dose equivalent rate was below the lower limit of detection of a CR-39 etched track detector and below 0.14 +/- 0.02 muSv h(-1) with a proportional counter, which is consistent, within the uncertainties, with natural background. The photon dose equivalent rate was also measured to be below background levels (0.1 muSv h(-1)) using an ionisation chamber and an optically stimulated luminescence dosemeter. A Monte Carlo simulation of neutron transport through the accelerator vault was performed to validate measured values and determine the thermal-energy to low-energy neutron component. Monte Carlo results showed that the dose equivalent rate from fast neutrons was reduced by a factor of 100,000 after attenuation through the vault wall, and the thermal-energy neutron dose equivalent rate would be an additional factor of 1000 below that of the fast neutrons. Based on these findings, the shielding installed in this facility is sufficient for the use of at least 5.0 mg of 252Cf.

Glucose down-regulates the expression of the peroxisome proliferator-activated receptor-alpha gene in the pancreatic beta -cell.

To better understand the action of glucose on fatty acid metabolism in the beta-cell and the link between chronically elevated glucose or fatty acids and beta-cell decompensation in adipogenic diabetes, we investigated whether glucose regulates peroxisomal proliferator-activated receptor (PPAR) gene expression in the beta-cell. Islets or INS(832/13) beta-cells exposed to high glucose show a 60-80% reduction in PPARalpha mRNA expression. Oleate, either in the absence or presence of glucose, has no effect. The action of glucose is dose-dependent in the 6-20 mm range and maximal after 6 h. Glucose also causes quantitatively similar reductions in PPARalpha protein and DNA binding activity of this transcription factor. The effect of glucose is blocked by the glucokinase inhibitor mannoheptulose, is partially mimicked by 2-deoxyglucose, and is not blocked by the 3-O-methyl or the 6-deoxy analogues of the sugar that are not phosphorylated. Chronic elevated glucose reduces the expression levels of the PPAR target genes, uncoupling protein 2 and acyl-CoA oxidase, which are involved in fat oxidation and lipid detoxification. A 3-day exposure of INS-1 cells to elevated glucose results in a permanent rise in malonyl-CoA, the inhibition of fat oxidation, and the promotion of fatty acid esterification processes and causes elevated insulin secretion at low glucose. The results suggest that a reduction in PPARalpha gene expression together with a rise in malonyl-CoA plays a role in the coordinated adaptation of beta-cell glucose and lipid metabolism to hyperglycemia and may be implicated in the mechanism of beta-cell "glucolipotoxicity."

Activation of malonyl-CoA decarboxylase in rat skeletal muscle by contraction and the AMP-activated protein kinase activator 5-aminoimidazole-4-carboxamide-1-beta -D-ribofuranoside.

Alterations in the concentration of malonyl-CoA, an inhibitor of carnitine palmitoyltransferase I, have been linked to the regulation of fatty acid oxidation in skeletal muscle. During contraction decreases in muscle malonyl-CoA concentration have been related to activation of AMP-activated protein kinase (AMPK), which phosphorylates and inhibits acetyl-CoA carboxylase (ACC), the rate-limiting enzyme in malonyl-CoA formation. We report here that the activity of malonyl-CoA decarboxylase (MCD) is increased in contracting muscle. Using either immunopurified enzyme or enzyme partially purified by (NH(4))(2)SO(4) precipitation, 2-3-fold increases in the V(max) of MCD and a 40% decrease in its K(m) for malonyl-CoA (190 versus 119 micrometer) were observed in rat gastrocnemius muscle after 5 min of contraction, induced by electrical stimulation of the sciatic nerve. The increase in MCD activity was markedly diminished when immunopurified enzyme was treated with protein phosphatase 2A or when phosphatase inhibitors were omitted from the homogenizing solution and assay mixture. Incubation of extensor digitorum longus muscle for 1 h with 2 mm 5-aminoimidazole-4-carboxamide-1-beta-d-ribofuranoside, a cell-permeable activator of AMPK, increased MCD activity 2-fold. Here, too, addition of protein phosphatase 2A to the immunopellets reversed the increase of MCD activity. The results strongly suggest that activation of AMPK during muscle contraction leads to phosphorylation of MCD and an increase in its activity. They also suggest a dual control of malonyl-CoA concentration by ACC and MCD, via AMPK, during exercise.

Occupational ingestion of P-32: the value of monitoring techniques to determine dose. A case report.

The purpose of this article is to described the analytical methods used to assess the internal dose from a P-32-labeled compound that was inadvertently ingested. Bioassay data, using the International Commission on Radiation Protection (ICRP)-30 model, enabled the calculation of internal dose. Whole body counting (WBC) and urinary measurement with liquid scintillation counting were utilized to estimate the amount of radioactive material deposited in body organs. This metabolic model assumes that 80% of the material ingested is absorbed through the gastrointestinal tract because P-32 is soluble. The time of the intake, a critical variable in this method, was estimated on the basis of urine contamination of clothing. Twenty-four-hour urine sampling over a 6-week period, coupled with daily WBC over the same period, was performed. Because P-32 does not emit photons, WBC relied on measuring the bremsstrahlung radiation produced as a result of interaction of beta radiation with the body's tissues. A P-32-spiked phantom was used as a control. Over the 6-week monitoring period, urinary results indicated an ingestion of 560 microCi of P-32, whereas WBC estimated on intake of 580 microCi. An assessment of the laboratory where the accident occurred indicated that approximately 600 microCi of radioactive phosphorous was missing. The total effective dose equivalent was estimated at 4.8 rem (48 mSv). On the basis of this study, the ICRP model appears to fit the data obtained from urine measurements and WBC. No symptoms were noted from the ingestion of 580 microCi. The committed organ doses were well within the occupational nonstochastic limits of 50 (0.5 Sv) permitted by the Nuclear Regulatory Commission. These results were confirmed by NUREG/CR-4884 and commercial software (CINDY). This report confirms the value of using the ICRP-30 model with urinary measurements and WBC to estimate the dose received as a result of ingestion of radioactive P-32.

The hemoregulatory peptide N-acetyl-ser-asp-lys-pro impairs angiotensin I-induced contractions in rat aorta.

The hemoregulatory peptide N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) is degraded by ACE. This study was designed to examine the effect of Ac-SDKP on the contractions to angiotensin I. Experiments were performed on rat aortic rings with endothelium exposed to nitro-L-arginine. Ac-SDKP (10 and 100 microM) significantly augmented angiotensin I ED20 (from 2.0+/-0.4 to 4.2+/-1.0 and 5.0+/-0.9 nM) and ED50 (from 4.3+/-0.7 to 8.6+/-1.0 and 10.7+/-1.3 nM, respectively), but did not alter its maximal response. The contractions to angiotensin II were not affected by Ac-SDKP. No degradation of exogenous Ac-SDKP nor detectable release of endogenous Ac-SDKP were observed in the incubation medium. These results suggest that Ac-SDKP impairs angiotensin I response by inhibiting ACE and subsequent angiotensin II formation.

Model for inactivation and disposal of infectious human immunodeficiency virus and radioactive waste in a BL3 facility.

A method is described for autoclaving low levels of solid infectious, radioactive waste. The method permits steam penetration to inactivate biologic waste, while any volatile radioactive compounds generated during the autoclave process are absorbed. Inactivation of radiolabeled infectious waste has been problematic because the usual sterilization techniques result in unacceptable radiation handling practices. If autoclaved under the usual conditions, there exists a high probability of volatilization or release of radioisotopes from the waste. This results in the radioactive contamination of the autoclave and the laboratory area where steam is released from the autoclave. Our results provide a practical method to inactivate and dispose of infectious radioactive waste. For our research, Bacillus pumilus spore strips and vaccinia virus were used as more heat-resistant surrogates of the human immunodeficiency virus (HIV). These surrogates were used because HIV is difficult to grow under most conditions and is less heat tolerant than the surrogates. In addition, B. pumilus has defined cell death values, whereas such values have not been established for HIV. Both B. pumilus and vaccinia virus are less hazardous to work with. The autoclave method is time efficient and can be performed by laboratory personnel with minimal handling of the waste. Furthermore, waste site handlers are able to visually inspect the solid waste containers and ascertain that inactivation procedures have been implemented.