Quantifying Quality of Reaching Movements Longitudinally Post-Stroke: A Systematic Review.

BACKGROUND: Disambiguation of behavioral restitution from compensation is important to better understand recovery of upper limb motor control post-stroke and subsequently design better interventions. Measuring quality of movement (QoM) during standardized performance assays and functional tasks using kinematic and kinetic metrics potentially allows for this disambiguation. OBJECTIVES: To identify longitudinal studies that used kinematic and/or kinetic metrics to investigate post-stroke recovery of reaching and assess whether these studies distinguish behavioral restitution from compensation. METHODS: A systematic literature search was conducted using the databases PubMed, Embase, Scopus, and Wiley/Cochrane Library up to July 1st, 2020. Studies were identified if they performed longitudinal kinematic and/or kinetic measurements during reaching, starting within the first 6 months post-stroke. RESULTS: Thirty-two longitudinal studies were identified, which reported a total of forty-six different kinematic metrics. Although the majority investigated improvements in kinetics or kinematics to quantify recovery of QoM, none of these studies explicitly addressed the distinction between behavioral restitution and compensation. One study obtained kinematic metrics for both performance assays and a functional task. CONCLUSIONS: Despite the growing number of kinematic and kinetic studies on post-stroke recovery, longitudinal studies that explicitly seek to delineate between behavioral restitution and compensation are still lacking in the literature. To rectify this situation, future studies should measure kinematics and/or kinetics during performance assays to isolate restitution and during a standardized functional task to determine the contributions of restitution and compensation.

A nationwide survey of hospital-based thalassemia patients and standards of care and a preliminary assessment of the national prevention program in Sri Lanka.

OBJECTIVES: Our aim was to describe the numbers and distribution of patients with different types of thalassemia and to assess the standards of care in all thalassemia treatment centers throughout Sri Lanka and the success of the ongoing prevention programme. METHODS: This cross-sectional island-wide survey was conducted by two trained medical graduates, who visited each thalassemia center to collect data from every patient, using a standardized form. Data was collected through review of patient registers and clinical records. RESULTS: We collected data on 1774 patients from 23 centers. 1219 patients (68.7%) had homozygous ß-thalassemia, 360 patients (20.3%) had hemoglobin E ß-thalassemia, and 50 patients (2%) had sickle ß-thalassemia. There were unacceptably high serum ferritin levels in almost all centers. The annual number of births of patients with ß-thalassaemia varied between 45-55, with little evidence of reduction over 19 years. CONCLUSIONS: Central coordination of the treatment and ultimately prevention of thalassemia is urgently needed in Sri Lanka. Development of expert centers with designated staff with sufficient resources will improve the quality of care and is preferred to managing patients in multiple small units.

Can we predict which dysplastic hips will require acetabular augmentation during total hip arthroplasty based on pre-operative radiographs?

AIMS: The purpose of this study was to evaluate whether an innovative templating technique could predict the need for acetabular augmentation during primary total hip arthroplasty for patients with dysplastic hips. PATIENTS AND METHODS: We developed a simple templating technique to estimate acetabular component coverage at total hip arthroplasty, the True Cup: False Cup (TC:FC) ratio. We reviewed all patients with dysplastic hips who underwent primary total hip arthroplasty between 2005 and 2012. Traditional radiological methods of assessing the degree of acetabular dysplasia (Sharp's angle, Tönnis angle, centre-edge angle) as well as the TC:FC ratio were measured from the pre-operative radiographs. A comparison of augmented and non-augmented hips was undertaken to determine any difference in pre-operative radiological indices between the two cohorts. The intra- and inter-observer reliability for all radiological indices used in the study were also calculated. RESULTS: Of the 128 cases reviewed, 33 (26%) needed acetabular augmentation. We found no difference in the median Sharp's angle (p = 0.10), Tönnis angle (p = 0.28), or centre-edge angle (p = 0.07) between the two groups. A lower TC:FC ratio was observed in the augmented group compared with the non-augmented group (median = 0.66 versus 0.88, p < 0.001). Intra-observer reliability was found to be high for all radiological indices analysed (interclass correlation coefficient (ICC) > 0.7). However, inter-observer reliability was more variable and was only high for the TC: FC ratio (ICC > 0.7). CONCLUSION: The TC: FC ratio gives an accurate estimate of acetabular component coverage. It can help predict which dysplastic hips are likely to need acetabular augmentation at primary total hip arthroplasty. It has high intra- and inter-observer reliability. Cite this article: Bone Joint J 2017;99-B:445-50.

Outcome of female urethral reconstruction: a 12-year experience.

INTRODUCTION AND HYPOTHESIS: To report our experience over 12 years in female urethral reconstruction with either anterior bladder tube (Tanagho) or labia minora pedicled tube. PATIENTS AND METHODS: This retrospective study included 16 patients with posttraumatic urethral loss. The patients were divided into two groups. Group I: included 6 patients managed with combined vaginal and abdominal approach using a proximally based anterior bladder tube (Tanagho) and Group II: included 10 patients underwent repair with labial fat pad flap with concomitant TOT sling. Outcomes included the success or failure of anatomical repair and continence, which was assessed during patient follow up by voiding diary, 24-h pad test and uroflowmetry. RESULTS: A total of 15 patients were followed for a mean of 42 months postoperatively, and only one patient was lost to follow up. Total continence was achieved in 10 patients (66.6 %) [4/6 patients (66.6 %) in group I and 6/9 patients (66.6 %) in group II]. Partial continence (i.e., one or two pad per day) was achieved in 2 patients (13.3 %). Failure occurs in 3 cases (20 %) [one case in group I and two cases in group II]. All our patients had a smooth postoperative course. In the labia pedicled tube, meatal stenosis was encountered in one patient and transient postoperative urine retention in 2 patients. Successful anatomical repair was achieved in all our patients. CONCLUSION: Both Bladder tube and labia minora pedicled tube with sling procedure have high success rate with only minor complications and are equally effective in the management of females with total urethral loss. Due to the small number of patients in this study, we still need to extend our study to verify our results.

Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia.

This study evaluated the effect of limb lengthening on longitudinal growth in patients with achondroplasia. Growth of the lower extremity was assessed retrospectively by serial radiographs in 35 skeletally immature patients with achondroplasia who underwent bilateral limb lengthening (Group 1), and in 12 skeletally immature patients with achondroplasia who did not (Group 2). In Group 1, 23 patients underwent only tibial lengthening (Group 1a) and 12 patients underwent tibial and femoral lengthening sequentially (Group 1b). The mean lengthening in the tibia was 9.2 cm (59.5%) in Group 1a, and 9.0 cm (58.2%) in the tibia and 10.2 cm (54.3%) in the femur in Group 1b. The mean follow-up was 9.3 years (8.6 to 10.3). The final mean total length of lower extremity in Group 1a was 526.6 mm (501.3 to 552.9) at the time of skeletal maturity and 610.1 mm (577.6 to 638.6) in Group 1b, compared with 457.0 mm (411.7 to 502.3) in Group 2. However, the mean actual length, representing the length solely grown from the physis without the length of distraction, showed that there was a significant disturbance of growth after limb lengthening. In Group 1a, a mean decrease of 22.4 mm (21.3 to 23.1) (4.9%) was observed in the actual limb length when compared with Group 2, and a greater mean decrease of 38.9 mm (37.2 to 40.8) (8.5%) was observed in Group 1b when compared with Group 2 at skeletal maturity. In Group 1, the mean actual limb length was 16.5 mm (15.8 to 17.2) (3.6%) shorter in Group 1b when compared with Group 1a at the time of skeletal maturity. Premature physeal closure was seen mostly in the proximal tibia and the distal femur with relative preservation of proximal femur and distal tibia. We suggest that significant disturbance of growth can occur after extensive limb lengthening in patients with achondroplasia, and therefore, this should be included in pre-operative counselling of these patients and their parents.

Bromoanaindolone, a novel antimicrobial exometabolite from the cyanobacterium Anabaena constricta.

A new brominated indole alkaloid, designated as bromoanaindolone, was isolated from culture media of the cyanobacterium Anabaena constricta and was identified as 6-bromo-3-hydroxy-3-methyl-indol-2-one with a slight excess of the (3R) enantiomer. The molecular structure was elucidated on the basis of IR, MS and NMR data. This extracellular metabolite of A. constricta possessed antimicrobial (anticyanobacterial and antibacterial) activity in different test systems, such as suspension and porous matrix tests.

Diagnosis of Ornithobacterium rhinotracheale infection in chickens by ELISA.

Specific Ornithobacterium rhinotracheale (ORT) antibodies were determined in serum samples of 24 clinically infected broiler flocks of different ages (1-42 d) and 11 broiler-breeding flocks (at ages between 26-56 w) by ELISA. Two commercially available kits were separately assessed. The BioCheck ELISA kit was used for testing 363 serum samples representing 12 broiler flocks, where 74 samples (20.3 %) were found to be positive and 49 (13.5 %) were suspected. The IDEXX ELISA kit was used for testing 148 serum samples representing different 12 broiler flocks, where 115 samples (77.7 %) were positive. Testing of additional 70 serum samples from 5 broiler- breeder flocks, associated with drop in egg production (1-4.5 %) at different ages, by BioCheck ELISA kit revealed that 78.5 % of the samples were positive and 21.4% were suspected. On the other hand, 338 serum samples representing 6 broiler-breeder flocks, associated also with egg drop, showed a 84.6 % rate of positive reaction, when tested by IDEXX ELISA kit. Positive serology correlated well with the clinical manifestations and isolation of the organism, which substantiates the reliability of the used kits in diagnosis of the disease.

Antimicrobial studies on methanol extract of benincasa hispida cogn., fruit.

The methanol extract of wax gourd, the fruits of Benincasa hispida cogn.(Cucurbitaceae) was found to show no inhibition against three gram positive bacteria Staphylococcus aureus, Staphylococcus epidermidis, and Bacillus subtilis and three gram negative bacteria Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumonia by cup-plate method whereas antifungal studies showed significant inhibition against Candida albicans in the concentration of 30 mg/ml and there was no inhibition against Aspergillus niger.

Stair-climbing test to evaluate maximum aerobic capacity early after lung resection.

BACKGROUND: The aim of this study was to investigate the extent of reduction in maximum oxygen consumption in the early postoperative period after lung resection for lung carcinoma. METHODS: A total of 115 patients who underwent lung resection (95 lobectomies, 20 pneumonectomies) performed a maximal stair-climbing test the day before operation and the day of discharge from the hospital (8 +/- 3.3 days after the operation). RESULTS: The postoperative test showed a 15% reduction in maximum oxygen consumption (VO2max) with respect to the preoperative test (Student's t test, p < 0.0001). This reduction was greater after pneumonectomy (21.4%) than after lobectomy (14%) (Student's t test, p < 0.05). A multiple regression analysis showed that the only significant independent predictors of both preoperative and postoperative VO2max were the age of the patient and the level of arterial oxygen content. CONCLUSIONS: The early postoperative reduction in VO2max was greater after pneumonectomy than after lobectomy and the exercise performance was significantly influenced by the level of arterial oxygen content both before and early after the operation.

Internal comparative audit in a thoracic surgery unit using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM).

OBJECTIVE: The aim of the study was to use the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) to assess the performance of our thoracic surgery unit during two successive periods of activity. METHODS: From 1992 through 1997, 801 candidates for thoracic procedures at our institution were considered for the study. After validation of the logistic regression model, including the POSSUM score, observed and POSSUM-predicted morbidities were compared within two groups of patients divided by year of operation (group 1: 1992-1994, n=362; group 2: 1995-1997, n=439) by means of the z-test for the comparison of a proportion with an expected value. RESULTS: The POSSUM-predicted morbidity was significantly lower than the observed one in the first period of activity of our unit (19.6 vs. 24.3%, respectively; z-test for the comparison of a proportion with an expected value, 2.25; P=0.01), whereas no difference was found in the second period (20.5 vs. 19.1%, respectively; z-test for the comparison of a proportion with an expected value, -0.71; P=0.76). CONCLUSIONS: The result suggests a worse-than-expected performance of our unit in the first period of activity, showing that POSSUM can be reliably applied as an instrument of internal comparative audit in a thoracic surgery unit.

Production and properties of beta-mannanase by free and immobilized cells of Aspergillus oryzae NRRL 3488.

Seven fungi were tested for production of mannanases. The highest mannanase activities were produced by Aspergillus oryzae NRRL 3488 after 7 days in static cultures. Mannanases were induced by gum locust bean (1.0%). The highest mannanase activity was produced when a mixture of peptone, urea and ammonium sulphate was used as nitrogen source. Zn2+ or Co2+ favoured enzyme production. The immobilized cells on Ca-alginate and agar were able to produce beta-mannanase for four runs with a slight decrease in the activity. The optimum temperature for enzyme reaction was 50-55 degrees C at pH 6.0. In the absence of substrate the enzyme was thermostable retaining 75% activity for 1 h at 50 degrees C, and 68% activity for 1 h at 60 degrees C.

Pleural tent after upper lobectomy: a prospective randomized study.

BACKGROUND: The aim of the present study was to assess the cost/efficacy of the pleural tent procedure after upper lobectomy. METHODS: A prospective randomized analysis was performed on 50 patients submitted to upper lobectomy and divided into two groups: group 1 (25 patients) with pleural tent; group 2 (25 patients) without pleural tent. RESULTS: The univariate comparison between the two groups did not show any significant difference in terms of age, gender, spirometry, smoking history, chronic obstructive pulmonary disease index, side of tumor, arterial oxygen tension, arterial carbon dioxide tension, size and location of tumor, presence of pleural adhesions, length of the stapled parenchyma, and operative time. Pleural tent significantly reduced the days of postoperative air leak (1.2 versus 5.8, p = 0.01), chest tubes (5.4 versus 10.4, p = 0.01), and hospital stay (6.9 versus 10.8, p = 0.01). Moreover, no difference was noted between the two groups in terms of pleural effusion in the first postoperative 48 hours, need of postoperative blood transfusion, and occurrence of other complications. CONCLUSIONS: Pleural tenting after upper lobectomy is a safe and effective procedure and its routine use is warranted.

Paraneoplastic syndromes in 68 cases of resectable non-small cell lung carcinoma: can they help in early detection?

The aim of this study was to assess the importance of paraneoplastic syndromes as an early sign of non-small cell lung cancer (NSCLC). A procedure for searching paraneoplastic syndromes, based on 40 years of reports in the literature, was established and the prevalence of paraneoplastic syndromes estimated in 68 patients with resectable NSCLC. Stages I and II were considered eligible for surgery straight away. Patients in Stage IIIA underwent surgery if partially or completely responsive to three courses of neo-adjuvant chemotherapy. Paraneoplastic syndromes were assessed and confirmed in nine patients (13%). Motor-sensory neuropathy, arthritis and arthralgias to the knees, periarthritis to the shoulder, hypertrophic osteopathy, clubbing, pruritus were observed. Only three patients with painful osteoarthropathies were diagnosed with NSCLC by tracing their paraneoplastic syndrome, whereas most of them (36/68) were diagnosed incidentally through a chest radiograph taken for tumour-unrelated symptoms. A careful research of paraneoplastic syndromes in high risk patients may guide the doctor to a resectable NSCLC diagnosis. Recent onset arthritis and arthralgias, which cannot be explained otherwise, should be considered to be early clues of lung cancer.

Serum and salivary IgG and IgA response to radiation therapy.

Patients undergoing radiotherapy for malignant tumors of the head and neck invariably develop extensive oral and dental diseases particularly when the major salivary glands are within the radiation fields. Unless the patient receives a strict oral hygiene home care and the teeth are protected by topical application of fluoride gel, caries or gingival disease onset inevitably follows radiation induced xerostomia is. The importance of saliva as a controlling factor in the development of oral diseases is underscored by the dramatic increase in dental decay and gingival diseases that inevitably follows the surgical extirpation of the major salivary glands in animals and the onset of xerostomia in man.

Detection and estimation of aflatoxins using both chemical and biological techniques.

Production of aflatoxins on both natural (rice and corn) and semisynthetic (YES) media was conducted using an identified toxin-producing strain ofAspergillus flavus. TheA flavus strain was able to produce 4 types of aflatoxins, namely B1, B2, G1, and G2 on rice, corn, and YES media. Quantitative data showed that the concentrations of aflatoxins B1 and G1 produced were 52, 40.3, and 39.6; and 64.7, 45.0, and 58.0jug for 50g of rice, corn, and YES media, respectively. In comparison, the yielded amounts of aflatoxins B2 and G2 were much lower: 11.5, 17.9, and 17.5; and 28.S, 40.3, and 39.5 µg for 50 g of rice, corn, and YES media, respectively.A bioassay was conducted using the following 5 standard bacterial strains:Bacillus megaterium. Bacillus subtilis, Streptococcus faecal is, Staphylococcus epidermidis, andParacoccus denitrificans as well as a field strain of Candida albicans. All strains exceptP denitrificans showed varied degrees of inhibition when applied with crude aflatoxins at 5 to 40µg/mL. The minimum concentration of crude aflatoxins needed to inhibitP denitrificans was 10µg/mL. Moreover,Candida albicans was not inhibited at any concentration of aflatoxins applied in this work.Both undiluted and diluted (1/10, 1/100, and 1/1000) bacterial broth cultures showed a direct relationship between the diameter of inhibition zones and the concentrations of crude aflatoxins. Mean diameters of (7.0-20.5), (5-14), (4.5-13.0), (3.0-12.0), and (1.5-11.0) mm were observed when various concentrations of aflatoxins were applied usingB megaterium, S epidermidis, S faecal is, B subtilis, andP denitrificans, respectively.Field trials were applied to testify the validity of our data. A 1/100 dilution was prepared from each strain of 4 different species to estimate aflatoxins in samples of contaminated corn. Both chemical and biological assays were carried out at the same time. Data revealed that the most sensitive organism inhibited by as low as 7.5µg aflatoxins/mL wasB megaterium giving an inhibition zone of 10.5 mm, followed byS epidermidis with an inhibition zone of 7.5mm. In relation, the other 2 organisms were less sensitive to crude aflatoxins. Similarly, the biological assay was applied to detect aflatoxins in some samples of wheat, corn, peanut, rice, and poultry rations. Of the 14 wheat and 10 corn samples, only 4 wheat and 2 corn samples were found to be positive. The same results were obtained using TLC analysis.

Functional recovery after near complete traumatic deficit of the cervical cord lasting more than 24 h.

Two young men presented with a complete cervical cord deficit associated with bilateral C4-C5 dislocation and 11 mm encroachment (sagittal narrowing) of the spinal canal in one case and near complete cervical cord deficit due to a crush fracture of the C7 vertebral body with 9 mm axial compression and 50% antero-posterior encroachment of the canal in the other case. There was no improvement within the first 24 h. Both patients left the hospital walking after open surgical realignment and complete cord decompression.