Reliability and Minimal Detectable Change for Sit-to-Stand Tests and the Functional Gait Assessment for Individuals With Parkinson Disease.

BACKGROUND AND PURPOSE: This study examined test-retest relative (intraclass correlation coefficient [ICC]) and absolute (minimum detectable change [MDC]) reliabilities for the 5 times sit-to-stand (5×STS), 30-second sit-to-stand (30sSTS), and the functional gait assessment (FGA) tests in people with Parkinson disease (PD). In addition, correlation of these functional tests with a history of falls was examined over a 6-month period, and the internal consistency of the FGA was established. METHODS: Twenty-two patients with PD (Hoehn and Yahr stages 1-3) completed 3 functional tests over 2 test-retest periods of 6 to 8 days. Falls were self-reported for the prior 6 months. RESULTS AND DISCUSSION: Moderate-to-excellent test-retest ICC(2,2) and MDC95 values were found for the 30sSTS (0.94, 3 times) and ICC(2,1) and MDC95 values were found for the FGA (0.86, 4 points). The 5×STS demonstrated a lower ICC(2,2) and a high MDC95 value (0.74, 10 seconds). A significant correlation was only found between past falls and the FGA test (r =-0.48, P < .05) during session 1. Cronbach α values for the 10-item FGA during session 1 and session 2 were 0.75 and 0.85, respectively. CONCLUSIONS: To assess for change over time, we found the 30sSTS and the FGA tests can be used reliably in patients with PD. A lower FGA score was associated with a higher chance of falls, and good internal consistency of the FGA was found.

Neuroscience Literacy: "Brain Tells" as Signals of Brain Dysfunction Affecting Daily Life.

The structures and circuits of the central and the peripheral nervous systems provide the basis for thinking, speaking, experiencing sensations, and performing perceptual and motor activities in daily life. Healthy people experience normal functioning without giving brain functions a second thought, while dysfunction of the neural circuits may lead to marked impairments in cognition, communication, sensory awareness, and performing perceptual and motor tasks. Neuroscience literacy provides the knowledge to associate the deficits observed in patients with the underlying deficits in the structures and circuits of the nervous system. The purpose of this paper is to begin the conversation in this area via a neuroscience literacy model of "Brain Tells," defined as stereotypical or observable behaviors often associated with brain dysfunction. Occupational therapists and other allied health professionals should be alert for the signs of "Brain Tells" that may be early warning signs of brain pathology. We also suggest that neuroscience literacy be emphasized in training provided to public safety workers, teachers, caregivers, and health care professionals at all levels.

Pulmonary fibrosis in dyskeratosis congenita: report of 2 cases.

Dyskeratosis congenita (DC) is a disorder of poor telomere maintenance and is related to 1 or more mutations that involve the vertebrate telomerase RNA component. Most affected patients develop mucocutaneous manifestations and cytopenias in the peripheral blood between 5 and 15 years of age. DC patients may also develop pulmonary complications including fibrotic interstitial lung disease and pulmonary vascular abnormalities. The radiologic and pathologic features of pulmonary fibrosis associated with DC are poorly defined. Herein, we report 2 new DC cases and suggest that the radiologic and histopathologic findings may resemble usual interstitial pneumonia but may not neatly fit into the current classification of interstitial lung disease.

Long-term exercise training for an individual with mixed corticobasal degeneration and progressive supranuclear palsy features: 10-year case report follow-up.

BACKGROUND AND PURPOSE: This case report describes the effects of long-term (10-year) participation in a community exercise program for a client with mixed features of corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP). The effects of exercise participation on both functional status and brain volume are described. CASE DESCRIPTION: A 60-year-old male dentist initially reported changes in gait and limb coordination. He received a diagnosis of atypical CBD at age 66 years; PSP was added at age 72 years. At age 70 years, the client began a therapist-led community group exercise program for people with Parkinson disease (PD). The program included trunk and lower extremity stretching and strengthening, upright balance and strengthening, and both forward and backward treadmill walking. The client participated twice weekly for 1 hour for 10 years and was reassessed in years 9 to 10. OUTCOMES: Falls (self-reported weekly over the 10-year period of the study by the client and his wife) decreased from 1.9 falls per month in year 1 to 0.3 falls per month in year 10. Balance, walking endurance, and general mobility declined slightly. Gait speed (both comfortable and fast) declined; the client was unable to vary gait speed. Quantitative brain measurements indicated a slow rate of whole brain volume loss and ventricular expansion compared with clients with autopsy-proven CBD or PSP. DISCUSSION: This client has participated consistently in a regular group exercise program for 10 years. He has reduced fall frequency, maintained balance and endurance, and retained community ambulation using a walker. Combined with the slow rate of brain volume loss, this evidence supports the efficacy of a regular exercise program to prolong longevity and maintain function in people with CBD or PSP.

Correlation between HER2 determined by fluorescence in situ hybridization and reverse transcription-polymerase chain reaction of the oncotype DX test.

The human epidermal growth factor receptor 2 (HER2) gene is amplified and its protein product overexpressed in about 20% of invasive breast cancers. Despite more than a decade of efforts to standardize HER2 testing, controversy persists regarding the most optimal testing method. Recently, Oncotype DX reports have begun including HER2 results in addition to the previously reported Recurrence Score. We compared HER2 results obtained by fluorescence in situ hybridization (FISH) in our laboratories with HER2 results obtained by reverse transcription-polymerase chain reaction (RT-PCR) as documented in the Oncotype DX report. We then sought to identify potentially significant characteristics in the discrepant cases. We identified breast cancer patients with estrogen receptor-positive, lymph node-negative tumors who had Oncotype DX testing performed between September 2008 and March 2012. Patient and tumor characteristics including HER2 FISH and Oncotype DX test results were recorded. Image analysis was performed on cases with discrepancy between the HER2 FISH and Oncotype DX HER2 results to determine the relative proportion of invasive tumor. Eight of 194 (4.1%) cases showed discrepancy between HER2 FISH and Oncotype DX RT-PCR results. Although the overall percent agreement (96%) and percent negative agreement (100%) were high, percent positive agreement was only 50%. Three of 8 (38%) discrepant cases showed heterogeneous amplification by FISH. Seven of 8 (88%) discrepant cases had <50% invasive tumor in the Oncotype DX tissue block. Percent positive agreement between HER2 FISH and Oncotype DX RT-PCR is low. Multiple factors may contribute to this discrepancy including a suboptimal microdissection and possibly heterogeneous amplification of HER2 gene in some cases.

Concordance between tissue microarray and whole-section estrogen receptor expression and intratumoral heterogeneity.

Hormone receptor status determination for breast cancer is an important part of pathologists' daily sign outs and many retrospective and prospective studies. In this study, we compared the estrogen receptor (ER) expression tested on tissue microarray (TMA) sections to those tested on whole sections (WS) to find out concordance and frequency of intratumoral heterogeneity. Five and one-half percent of all tumors showed discrepancy in ER expression between TMA and WS. The rate of discrepancy was lower with increasing number of cores from individual cases. In 1.4% of cases, there was discrepancy in ER expression between cores in which >1 core was available on TMA section. We concluded that TMA can be used to determine ER status with good concordance to ER determination done on WS. Whenever the size of the tumor in the block allows it, more cores should be taken to construct TMAs.

Community-based exercise and wellness program for people diagnosed with Parkinson disease: experiences from a 10-month trial.

OBJECTIVE: This study considered whether a therapy community could create an infrastructure for developing and maintaining a service delivery model grounded in a clinic-based physiotherapy model. A longitudinal clinical study was conducted to assess the abilities of participants with Parkinson disease in a 10-month community exercise program. METHODS: Fifteen individuals averaging stage 3 on the Hoehn and Yahr scale, 6 years since Parkinson disease diagnosis, and 72 years old, participated. RESULTS: Graphical analysis of ambulation endurance demonstrated the strongest improvement over time (11%). Walking speeds, balance, and mobility showed a maintenance effect over the 10 months. The total unified Parkinson disease rating scale, activities of daily living subscale, and motor subscale remained statistically unchanged in the study. Scores on the unified Parkinson disease rating scale mentation, behavior, and mood subscale improved by 38%. None of the scores met or exceeded the minimal detectable change, MDC95 but two scores demonstrated more than 10% change. CONCLUSION: This clinical study implemented previous short-term research findings into an ongoing community wellness program for individuals with Parkinson disease. No community-based studies have demonstrated an ability to maintain a group for an extended time frame. Group exercise including forward and backward treadmill training, designed and monitored by a physical therapist, may improve or maintain functional outcomes.

Barriers to physical activity between adults with stroke and their care partners.

BACKGROUND AND PURPOSE: Healthy living includes meeting daily physical activity guidelines. This study compares daily physical activity rates and barriers to physical activity for people with stroke and their partners (spouse or significant other). METHODS: Physical abilities, energy expenditure, daily steps, and barriers to physical activity are evaluated in people who have completed stroke rehabilitation and their partners. RESULTS: Twenty pairs of adults (mean age 69.7 years) participated. Participants with stroke were classified as sedentary, averaging 2,990 (± 2,488) steps per day. Their partners are classified as low active, averaging 6,378 (± 2,149) steps per day. For stroke survivors, physical abilities were positively correlated to daily activity rates. The number of steps walked per day was moderately correlated to 6-minute walk tests (r = 0.550, P < .05), comfortable gait speeds (r = 0.588, P < .05), and fast gait speeds (r = 0.677, P < .01). For care partners, physical abilities were not correlated to daily physical activity. People with stroke report lack of skill as a primary barrier; their partners report lack of time. CONCLUSIONS: The relationship between physical ability and physical activity is reinforced with this study. The impact of stroke on the family, particularly on time demands of the primary caregiver, suggests the needs of the care partner may not be adequately addressed in the rehabilitation process.

Cysteine-rich domains of muc3 intestinal mucin promote cell migration, inhibit apoptosis, and accelerate wound healing.

BACKGROUND & AIMS: Muc3 intestinal mucin contains an extracellular cysteine-rich domain with 2 epidermal growth factor (EGF)-like motifs. The aim of this study was to determine the functional properties of Muc3 proteins. METHODS: Glutathione S-transferase-fusion proteins containing both Muc3 EGF-like domains (m3EGF1,2) or truncated versions (m3EGF1 and m3EGF2) were purified from Escherichia coli. Mouse colon (young adult mouse colon) and human A431 and LoVo cells were examined for migration and tyrosine phosphorylation in response to recombinant proteins. LoVo cells were transfected with a human MUC3A transmembrane-EGF1,2 construct and a stable clone was isolated (LhM3c14). Endogenous MUC3A in LoVo was inhibited by specific small interfering RNA transfection. Apoptosis was quantitated by nuclear morphology or terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick-end labeling assay. Colitis was induced in mice by oral 5% dextran sodium sulfate or rectal 5% acetic acid, followed by enema treatments. RESULTS: m3EGF1,2 stimulated cell migration in all cell lines, but did not induce proliferation. Migration was inhibited by a tyrosine phosphorylation inhibitor, genistein, but not by the EGF receptor inhibitor, tyrphostin (AG1478). Inhibition of endogenous MUC3A in LoVo reduced baseline migration. Tyrosine phosphorylation of ErbB receptors was not observed after treatment of cells with m3EGF1,2. LoVo cells pretreated with m3EGF1,2 and transfected LhM3c14 cells showed reduced apoptosis in response to tumor necrosis factor alpha or Fas-receptor stimulation. Administration of m3EGF1,2 per rectum significantly reduced mucosal ulceration and apoptosis in experimental acute colitis. Truncated proteins m3EGF1 and m3EGF2 had no effect. CONCLUSIONS: The Muc3 mucin cysteine-rich domain plays an active role in epithelial restitution, and represents a potential novel therapeutic agent for intestinal wound healing.

Perceived and measured hearing ability in construction laborers and farmers.

BACKGROUND: Construction and farming are characterized by small independently operated enterprises; few are included in hearing loss prevention programs. This study describes perceived and measured hearing ability among construction laborers and farmers in order to further the Healthy People 2010 goal to reduce noise-induced hearing loss (NIHL). METHODS: Construction laborers (n = 147) and farmers (n = 150) had screening audiograms at their workplace and a farm show, respectively. The relationship of the audiograms with a one-item measure of perceived hearing ability was explored using non-parametric statistics. RESULTS: At the 4,000 Hz frequency, indicative of NIHL, a high percentage of both groups exhibited hearing loss greater than 25 dB: laborers 53%, farmers 67%. Perceived hearing ability was significantly worse (P < 0.05) for workers with a measured hearing loss. The sensitivities of perceived hearing loss compared to audiometry ranged from 0.30 to 0.72 suggesting that perceived hearing loss was not a good indicator of actual hearing loss in this sample. CONCLUSIONS: The poor relationship between perceived and actual hearing loss in this study suggests that best practice requires inclusion of audiometric screening as part of a complete hearing loss prevention program. Future development of an improved instrument to measure perceived hearing ability may be useful in assessing this dimension of hearing.