Visual-spatial training in patients with sub-acute stroke without neglect: a randomized, single-blind controlled trial.

Many people who have suffered a stroke will experience sensorimotor impairments that disrupt their performance of motor skills, including balance and gait. Furthermore, stroke-induced brain damage can Result in visual disorders that may significantly impact performance of normal daily activities. The primary aim of this study was to investigate the effects, on balance, of visual-spatial training as an add-on intervention to conventional neurorehabilitation in patients with subacute stroke without neglect; secondarily, it aimed to assess the effects of this training on activities of daily living. Thirty inpatients (17 M, age: 57.3±12.9 years) with a diagnosis of subacute stroke (< 180 days) were enrolled in this study and randomized into two groups: the visual-spatial training group and a control group. All patients were evaluated, using the Tinetti Balance and Gait Scale (TBG), the Berg Balance Scale, computerized posturography, and the Barthel Index (BI), both before (T0) and after (T1) four weeks of training sessions. In addition to conventional neurorehabilitation, each group performed a total of twelve 20-minute rehabilitation sessions (3 times/week for 4 weeks). Significant TIME x GROUP interactions were recorded in the experimental group with respect to the control group for the TBG score [F (1,18) =15.59; p = 0.0004] and BI score [F (1,28) =6.35; p = 0.01]. Both groups recorded non-significant improvements on the instrumental postural assessment. These data suggest that visualspatial training as an add-on intervention to conventional neurorehabilitation could be an effective complementary strategy to improve balance and activities of daily living.

Cardiopulmonary exercise test predicts sustained ventricular arrhythmias in chronic heart failure.

BACKGROUND: The cardiopulmonary exercise test (CPX) is an affordable tool for risk prediction in patients with chronic heart failure (CHF). We aimed to determine the role of CPX parameters in predicting the risk of incidence of sustained ventricular arrhythmias (SVA) in CHF. METHODS: Sixty-one consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent CPX and were followed for 327 ± 247 days. Clinical follow-up was performed every month and anticipated in case of re-hospitalisation for cardiac disease. Incidence of SVA was evaluated by direct clinical examination (ECG, ambulatory ECG). RESULTS: Patients with episodes of SVA (N 14) showed lower values of pVO2 and PetCO2, and higher values of VE/VCO2, VE/VCO2 slope, and VE%. After correction for age, gender, diabetes, ischaemic heart disease and left ventricular ejection fraction, peak VO2 (hazard ratio (HR) 0.68, 95 % confidence interval (CI) 0.51-0.91, p < 0.05), VE% (HR 1.38, 95 % CI 1.04-1.84, p < 0.05), VE/VCO2 (HR 1.38, 95 % CI 1.04-1.82, p < 0.05), VE/VCO2 slope (HR 1.77, 95 % CI 1.31-2.39, p < 0.01), PetCO2 (HR 0.66, 95 % CI 0.50-0.88, p < 0.01) were found as predictors of SVA. At Kaplan-Meier analysis, lower event-free rates were found in subjects with peak VO2 values below median (log rank p < 0.05), values of VE/VCO2 above mean (p < 0.05), higher VE/VCO2 slope tertiles (p <0.05), and values of PetCO2 below median (p < 0.05). CONCLUSIONS: CPX provides prognostic independent information for risk of SVA in subjects with CHF.

The influence of the phase of the estrous cycle on sheep endometrial tissue response to lipopolysaccharide.

The effect of lipopolysaccharide on ovine endometrial tissue was examined at estrus (follicular phase) and during the luteal phase. Endometrial tissues were cultured with 0, 1, or 10 microg/mL lipopolysaccharide. After 24 h, culture supernates were harvested and analyzed for PGF2alpha, PGE2, 6-keto-PGF1alpha, thromboxane B2 (TXB2), and cysteinyl-leukotrienes (leukotrienes) using EIA. Homogenates of endometrial tissue were analyzed for prostaglandin endoperoxidase-1 (PTGS-1), and -2 (PTGS-2) as well as Type-I, -II, and -III nitric oxide synthase (NOS) by Western analysis. Follicular phase tissue produced more PGF2alpha (P < 0.001), TXB2 (P < 0.001), and leukotrienes (P < 0.02) than luteal tissue. Lipopolysaccharide increased PGE2 (P < 0.001) and TXB2 (P < 0.02) production by endometrial tissue. Elevations in these eicosanoids were likely due to the measured increases in PTGS-2 (P = 0.002) because no changes in PTGS-1 (P = 0.54) or Type-I, -II, or -III NOS (P > or = 0.20) occurred in endometrial tissue following lipopolysaccharide exposure. These data suggest that the phase of the estrous cycle regulates prostaglandin production by immune-challenged endometrial tissue.

Effects of ketanserin on the discrimination of electrical stimulation of the dorsal raphé nucleus in rats.

The electrical stimulation of the dorsal raphé nucleus was used as a training cue in a discrimination paradigm. Sprague-Dawley rats were trained to discriminate between electrical stimulation (ES; 200 microA) of the dorsal raphé nucleus (DRN) and non-stimulation. This was accomplished by associating ES with intraperitoneal (i.p.) injection of lithium chloride (LiCl), following the session with electrical stimulation. This made the drinking of saccharin during ES aversive by conditioned taste aversion. Following training, rats decreased saccharin consumption in ES sessions. This discrimination was learned within three pairings of the ES with LiCl. Lowering the ES current to 50-100 microA resulted in levels of saccharin consumption similar to non-stimulation levels, whereas 150 microA showed a response intermediate between the stimulation response at 200 microA and non-stimulation. The discrimination of ES of the DRN (200 microA) was not affected by prior administration of the 5-HT2 antagonist ketanserin (1 or 2 mg/kg, i.p.), suggesting that activation of 5-HT2 receptors is not the primary discriminative cue generated by ES. However, the 5-HT2A/2C agonist DOI (0.25-0.5 mg/kg, i.p.), substituted for ES of the DRN, i.e. animals reduced saccharin consumption following DOI administration. This substitution of DOI for ES was antagonized by the administration of ketanserin (1 mg/kg, i.p.). These results suggest that ES of the DRN has properties that are similar to the activation of 5-HT2A/2C receptors by DOI. However, other stimuli such as activation of other 5-HT receptors are also involved, given that the discriminative cues of ES are not blocked by the 5-HT2A/2C antagonist ketanserin.