bluuebunny/crossref_metadata_2025 huggingface dataset:
Proteomic definition of a desmoglein linear determinant common to Pemphigus vulgaris and Pemphigus foliaceous
Authors: Lucchese Alberta , Mittelman Abraham , Tessitore Luciana , Serpico Rosario , Sinha Animesh A , Kanduc Darja
Published: August 2006

Background

A number of autoimmune diseases have been clinically and pathologically characterized. In contrast, target antigens have been identified only in a few cases and, in these few cases, the knowledge of the exact epitopic antigenic sequence is still lacking. Thus the major objective of current work in the autoimmunity field is the identification of the epitopic sequences that are related to autoimmune reactions. Our labs propose that autoantigen peptide epitopes able to evoke humoral (auto)immune response are defined by the sequence similarity to the host proteome. The underlying scientific rationale is that antigen peptides acquire immunoreactivity in the context of their proteomic similarity level. Sequences uniquely owned by a protein will have high potential to evoke an immune reaction, whereas motifs with high proteomic redundancy should be immunogenically silenced by the tolerance phenomenon. The relationship between sequence redundancy and peptide immunoreactivity has been successfully validated in a number of experimental models. Here the hypothesis has been applied to pemphigus diseases and the corresponding desmoglein autoantigens.

Methods

Desmoglein 3 sequence similarity analysis to the human proteome followed by dot-blot/NMR immunoassays were carried out to identify and validate possible epitopic sequences.

Results

Computational analysis led to identifying a linear immunodominant desmoglein-3 epitope highly reactive with the sera from Pemphigus vulgaris as well as Pemphigus foliaceous. The epitopic peptide corresponded to the amino acid REWVKFAKPCRE sequence, was located in the extreme N-terminal region (residues 49 to 60), and had low redundancy to the human proteome. Sequence alignment showed that human desmoglein 1 and 3 share the REW-KFAK–RE sequence as a common motif with 75% residue identity.

Conclusion

This study 1) validates sequence redundancy to autoproteome as a main factor in shaping desmoglein peptide immunogenicity; 2) offers a molecular mechanicistic basis in analyzing the commonality of autoimmune responses exhibited by the two forms of pemphigus; 3) indicates possible peptide-immunotherapeutical approaches for pemphigus diseases.
Role of common human TRIM5α variants in HIV-1 disease progression
Authors: Goldschmidt Valérie , Bleiber Gabriela , May Margaret , Martinez Raquel , Ortiz Millàn , Telenti Amalio ,   The Swiss HIV Cohort Study
Published: August 2006

Background

The retroviral restriction factor tripartite motif protein (TRIM)5α, is characterized by marked amino acid diversity among primates, including specific clusters of residues under positive selection. The identification of multiple non-synonymous changes in humans suggests that TRIM5α variants might be relevant to retroviral pathogenesis. Previous studies have shown that such variants are unlikely to modify susceptibility to HIV-1 infection, or the course of early infection. However, the longterm effect of carrying Trim5α variants on disease progression in individuals infected with HIV-1 has not previously been investigated.

Methods

In a cohort of 979 untreated individuals infected with HIV-1 with median follow up 3.2 years and 9,828 CD4 T cell measurements, we analysed common amino acid variations: H43Y, V112F, R136Q, G249D, and H419Y. The rate of CD4 T cell decline before treatment was used as the phenotype. In addition, we extended previous work on the in vitro susceptibility of purified donor CD4 T cells (n = 125) to HIV-1 infection, and on the susceptibility of HeLa cells that were stably transduced with the different TRIM5 variants. Haplotypes were analysed according to the most parsimonious evolutionary structure, where two main human TRIM5α groups can be defined according to the residue at amino acid 136. Humans present both Q136 and R136 at similar frequency, and additional TRIM5α amino acid variants are almost exclusively derived from R136-carrying haplotypes.

Results

We observed modest differences in disease progression for evolutionary branches carrying R136-derived haplotypes, and with the non-synonymous polymorphisms G249D and H419Y. In vitro analysis of susceptibility of donor CD4 T cells, and of the various transduced HeLa cell lines supported the absence of significant differential restriction of HIV-1 infection by the various huTRIM5α alleles.

Conclusion

Common human variants of TRIM5α have no effect or modest effect on HIV-1 disease progression. These variants occur at sites conserved throughout evolution, and are remote from clusters of positive selection in the primate lineage. The evolutionary value of the substitutions remains unclear.
Ionic Basis of a Mechanotransduction Current in Adult Rat Dorsal Root Ganglion Neurons
Authors: McCarter Gordon C , Levine Jon D
Published: August 2006

Sensory mechanical transduction – necessary for hearing, proprioception, and the senses of touch and pain – remains poorly understood. In somatosensation, even the basic properties of the mechanically sensitive excitatory ionic currents that are assumed to mediate mechanical transduction are largely undescribed. We have recorded, from the soma of rat dorsal root ganglion (DRG) neurons in vitro, whole-cell ionic currents induced by the impact of a piezo-electrically driven glass probe. This transient mechanically activated current was observed in virtually all DRG neurons tested. In ion substitution experiments the current could be carried nonselectively by most cations, including divalent and organic cations, but not by chloride or sulfate ions. In addition, the mechanically activated current carried by monovalent cations was consistently blocked by millimolar concentrations of external calcium or magnesium. Based on these results, the transient mechanical transduction current observed in somatosensory neurons in vitro is mediated by large-pore mechanically gated channels nonselective for cations but impermeable to anions.
Activation of WNT and BMP signaling in adult human articular cartilage following mechanical injury
Authors: Dell'Accio Francesco , De Bari Cosimo , El Tawil Noha MF , Barone Francesca , Mitsiadis Thimios A , O'Dowd John , Pitzalis Costantino
Published: August 2006

Acute full thickness joint surface defects can undergo repair, which involves tissue patterning and endochondral bone formation. Molecular signals regulating this process may contribute to the repair outcome, chronic evolution and, eventually, the onset of osteoarthritis. We tested the hypothesis that mechanical injury modulates morphogenetic pathways in adult human articular cartilage explants. Adjacent articular cartilage explants were obtained from preserved areas of the femoral condyles of patients undergoing arthroplasty for osteoarthritis, or from a normal joint of a patient undergoing lower limb amputation. Paired explants were individually maintained in explant culture. From each pair, one explant was mechanically injured and the other left uninjured as a control. Cultures were terminated at different time points for histochemistry, immunohistochemistry and gene expression analysis by reverse transcription real time PCR. Bone morphogenetic protein 2 (BMP-2) mRNA was upregulated in the injured explants. We detected phosphorylation of SMAD-1 and SMAD-5, consistent with activation of the bone morphogenetic protein (BMP) pathway. FRZB-1 mRNA was downregulated in the injured explants, suggesting de-repression of WNT signaling. Accordingly, expression of the canonical WNT target genes Axin-2 and c-JUN was upregulated in the injured explants. Activation of the canonical WNT signaling pathway by LiCl treatment induced upregulation of COL2A1 and Aggrecan mRNA, suggesting an anabolic effect. Phosphorylation of SMAD-1/-5 and downregulation of FRZB were confirmed in vivo in a mouse model of joint surface injury. Taken together, these data show modulation of the BMP and WNT pathways following mechanical injury in vitro and in vivo, which may play a role in the reparative response of the joint surface. These pathways may, therefore, represent potential targets in protocols of biological joint surface defect repair.
Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis
Authors: Appel Heiner , Loddenkemper Christoph , Grozdanovic Zarko , Ebhardt Harald , Dreimann Marc , Hempfing Axel , Stein Harald , Metz-Stavenhagen Peter , Rudwaleit Martin , Sieper Joachim
Published: August 2006

Ankylosing spondylitis (AS) is a chronic inflammatory disease which affects primarily the sacroiliac joints and the spine. In patients with active disease, magnetic resonance imaging (MRI) of the spine shows areas of bone marrow edema, the histopathological equivalent of which is unknown. In this study we correlate inflammation in the spine of patients with AS as revealed by histological examination with bone marrow edema as detected by MRI. We have compared the histopathological findings of zygapophyseal joints from 8 patients with AS (age: 30 to 64, disease duration 7 to 33 years) undergoing spinal surgery with findings in MRI. For histopathological analysis, we quantified infiltrates of CD3+, CD4+ and CD8+ T cells as well as CD20+ B cells immunohistochemically. Bone marrow edema was evaluated in hematoxylin and eosin stained sections and quantified as the percentage of the bone marrow area involved. All patients with AS showed interstitial mononuclear cell infiltrates and various degrees of bone marrow edema (range from 10% to 60%) in histopathological analysis. However, in only three of eight patients histopathological inflammation and edema in the zygapophyseal joints correlated with bone marrow edema in zygapophyseal joints of the lumbar spine as detected by MRI. Interestingly, two of these patients showed the highest histological score for bone marrow edema (60%). This first study correlating histopathological changes in the spine of patients with AS with findings in MRI scans suggests that a substantial degree of bone marrow inflammation and edema is necessary to be detected by MRI.
In vitrosynergistic cytoreductive effects of zoledronic acid and radiation on breast cancer cells
Authors: Ural A Ugur , Avcu Ferit , Candir Muhammed , Guden Metin , Ozcan M Ali
Published: August 2006

Introduction

Bisphosphonates are mostly used in the treatment of bone metastases. They have been shown to act synergistically with other chemotherapeutic agents. It is not known, however, whether similar synergistic effects exist with radiation on breast cancer cells.

Methods

Human MCF-7 breast cancer cells were treated with up to 100 μM zoledronic acid, were irradiated with up to 800 cGy or were exposed to combinations of both treatments to determine the antiproliferative effects of zoledronic acid and radiation.

Results

Zoledronic acid and radiation caused a dose-dependent and time-dependent decrease in cell viability (approximate 50% growth inhibition values were 48 μM and 20 μM for 24 hours and 72 hours, respectively, for zoledronic acid and 500 cGy for radiation). A synergistic cytotoxic effect of the combination of zoledronic acid and radiation was confirmed by isobologram analysis.

Conclusion

These data constitute the firstin vitroevidence for synergistic effects between zoledronic acid and radiation. This combination therapy might thus be expected to be more effective than either treatment alone in patients with metastatic breast carcinoma.
Effects of descending positive end-expiratory pressure on lung mechanics and aeration in healthy anaesthetized piglets
Authors: Carvalho Alysson Roncally S , Jandre Frederico C , Pino Alexandre V , Bozza Fernando A , Salluh Jorge I , Rodrigues Rosana S , Soares João HN , Giannella-Neto Antonio
Published: August 2006

Introduction

Atelectasis and distal airway closure are common clinical entities of general anaesthesia. These two phenomena are expected to reduce the ventilation of dependent lung regions and represent major causes of arterial oxygenation impairment in anaesthetic conditions. The behaviour of the elastance of the respiratory system (Ers), as well as the lung aeration assessed by computed tomography (CT) scan, was evaluated during a descendent positive end-expiratory pressure (PEEP) titration. This work sought to evaluate the potential usefulness of Ers monitoring to set the PEEP in order to prevent tidal recruitment and hyperinflation of healthy lungs under general anaesthesia.

Methods

PEEP titration (from 16 to 0 cmH2O, tidal volume of 8 ml/kg) was performed, and at each PEEP, CT scans were obtained during end-expiratory and end-inspiratory pauses in six healthy, anaesthetized and paralyzed piglets. The distribution of lung aeration was determined and the tidal re-aeration was calculated as the difference between end-expiratory and end-inspiratory poorly aerated and normally aerated areas. Similarly, tidal hyperinflation was obtained as the difference between end-inspiratory and end-expiratory hyperinflated areas. Ers was estimated from the equation of motion of the respiratory system during all PEEP titration with the least-squares method.

Results

Hyperinflated areas decreased from PEEP 16 to 0 cmH2O (ranges decreased from 24–62% to 1–7% at end-expiratory pauses and from 44–73% to 4–17% at end-inspiratory pauses) whereas normally aerated areas increased (from 30–66% to 72–83% at end-expiratory pauses and from 19–48% to 73–77% at end-inspiratory pauses). From 16 to 8 cmH2O, Ers decreased with a corresponding reduction in tidal hyperinflation. A flat minimum of Ers was observed from 8 to 4 cmH2O. For PEEP below 4 cmH2O, Ers increased in association with a rise in tidal re-aeration and a flat maximum of the normally aerated areas.

Conclusion

In healthy piglets under a descending PEEP protocol, the PEEP at minimum Ers presented a compromise between maximizing normally aerated areas and minimizing tidal re-aeration and hyperinflation. High levels of PEEP, greater than 8 cmH2O, reduced tidal re-aeration but increased hyperinflation with a concomitant decrease in normally aerated areas.
In vitro modeling of the HIV-macrophage reservoir
Authors: Brown Amanda , Zhang Hao , Lopez Peter , Pardo Carlos A , Gartner Suzanne
Published: August 2006

Macrophages are recognized as a putative reservoir for HIV-1, but whether HIV can establish latent infection in this cell type is not known. An in vitro model using long-term cultured primary human monocyte-derived macrophages (MDM) infected with an M-tropic, enhanced green fluorescent protein (EGFP) tagged reporter virus was developed to test the hypothesis that HIV can establish a latent infection of this cell type. The EGFP-IRES-Nef cassette allowed detection of early gene transcription. The expression of GFP+ MDM was followed with time and the GFP- population was purified and analyzed for evidence of latent infection. Interestingly, in MDM cultures propagated for over two months, distinct subpopulations of infected GFP+ cells were observed and quantitated. In particular, infected MDM that displayed a high level of transcription, characterized as the GFP hi group, yet produced low levels of the late viral gene product, p24, increased with time and represented 10% of the GFP+ population in long-term cultures. The high level production of early genes such as Nef, a protein that can facilitate viral immune escape, but low level of structural proteins such as p24 in the GFP hi population suggests that a subset of infected MDM can exhibit an alternative mode of replication. The GFP- MDM population obtained by a two-step purification protocol using flow cytometry and laser ablation contained integrated provirus as assessed by Alu-LTR real-time PCR analyses. A subset of these, were replication competent as shown by their ability to express GFP and/or p24 antigen after reactivation with IL-4.
Anti-HIV-1 immunotoxin 3B3(Fv)-PE38: enhanced potency against clinical isolates in human PBMCs and macrophages, and negligible hepatotoxicity in macaques
Authors: Kennedy Paul E , Bera Tapan K , Wang Qing-Cheng , Gallo Maria , Wagner Wendeline , Lewis Mark G , Berger Edward A , Pastan Ira
Published: August 2006

Highly active antiretroviral therapy (HAART) against human immunodeficiency virus type 1 (HIV-1) infection dramatically suppresses viral load, leading to marked reductions in HIV-1 associated morbidity and mortality. However, infected cell reservoirs and low-level replication persist in the face of suppressive HAART, leading invariably to viral rebound upon cessation of treatment. Toxins engineered to target the Env glycoprotein on the surface of productively infected cells represent a complementary strategy to deplete these reservoirs. We described previously highly selective killing of Env-expressing cell lines by CD4(178)-PE40 and 3B3(Fv)-PE38, recombinant derivatives of Pseudomonas aeruginosa exotoxin A containing distinct targeting moieties against gp120. In the present report, we compare the in vitro potency and breadth of these chimeric toxins against multiple clinical HIV-1 isolates, replicating in biologically relevant primary human target cell types. In PBMCs, 3B3(Fv)-PE38 blocked spreading infection by all isolates examined, with greater potency than CD4(178)-PE40. 3B3(Fv)-PE38 also potently inhibited spreading HIV-1 infection in primary macrophages. Control experiments demonstrated that in both target cell types, most of the 3B3(Fv)-PE38 activity was due to selective killing of infected cells, and not merely to neutralization by the antibody moiety of the chimeric toxin. High-dose treatment of rhesus macaques with 3B3(Fv)-PE38 did not induce liver toxicity, whereas equivalent dosage of CD4(178)-PE40 induced mild hepatotoxicity. These findings highlight the potential use of 3B3(Fv)-PE38 for depleting HIV-infected cell reservoirs persisting in the face of HAART.
Retroviral E-DNA: persistence and gene expression in nondividing immune cells
Authors: Cara Andrea , Klotman Mary E
Published: August 2006

Following retroviral infection of cells, not only is the proviral DNA integrated into the host genome, but there is also an accumulation of unintegrated extrachromosomal DNA (E-DNA), both linear and circular. Although the integrated DNA is responsible for the production of viral proteins and new viral progeny, the role of E-DNA has remained uncertain. Several reports have shown that E-DNA is transcriptionally active producing both RNA, as well as viral proteins and that circular E-DNA can persist in nondividing cells, raising questions regarding the potential consequences of this reservoir. Furthermore, integrase inhibitors, presently in clinical trials, shifts the balance of proviral DNA to the E-DNA form. This review is focused on recent work in this field with an emphasis on exploring the potential role of E-DNA in both pathogenesis of retroviral infections, especially HIV-1, and as a tool to deliver and express genes.
HIV interactions with dendritic cells: has our focus been too narrow?
Authors: Donaghy Heather , Wilkinson John , Cunningham Anthony L
Published: August 2006

Although few in number, dendritic cells (DCs) are heterogeneous, ubiquitous, and are crucial for protection against pathogens. In this review, the different DC subpopulations have been described and aspects of DC biology are discussed. DCs are important, not only in the pathogenesis of HIV, but also in the generation of anti-HIV immune responses. This review describes the roles that DC are thought to play in HIV pathogenesis, including uptake and transport of virus. We have also discussed the effects that the virus exerts on DCs such as infection and dysfunction. Then we proceed to focus on DC subsets in different organs and show how widespread the effects of HIV are on DC populations. It is clear that the small number of studies on tissue-derived DCs limits current research into the pathogenesis of HIV.
Sensitivity of a computer adaptive assessment for measuring functional mobility changes in children enrolled in a community fitness programme
Authors: Haley Stephen M , Fragala-Pinkham Maria , Ni Pengsheng
Published: August 2006

Objective: To examine the relative sensitivity to detect functional mobility changes with a full-length parent questionnaire compared with a computerized adaptive testing version of the questionnaire after a 16-week group fitness programme.

Design: Prospective, pre- and posttest study with a 16-week group fitness intervention.

Setting: Three community-based fitness centres.

Subjects: Convenience sample of children ( n = 28) with physical or developmental disabilities.

Interventions: A 16-week group exercise programme held twice a week in a community setting.

Main measures: A full-length (161 items) paper version of a mobility parent questionnaire based on the Pediatric Evaluation of Disability Inventory, but expanded to include expected skills of children up to 15 years old was compared with a 15-item computer adaptive testing version. Both measures were administered at pre- and posttest intervals.

Results: Both the full-length Pediatric Evaluation of Disability Inventory and the 15- item computer adaptive testing version detected significant changes between pre and posttest scores, had large effect sizes, and standardized response means, with a modest decrease in the computer adaptive test as compared with the 161-item paper version. Correlations between the computer adaptive and paper formats across pre and posttest scores ranged from r = 0.76 to 0.86.

Conclusions: Both functional mobility test versions were able to detect positive functional changes at the end of the intervention period. Greater variability in score estimates was generated by the computerized adaptive testing version, which led to a relative reduction in sensitivity as defined by the standardized response mean. Extreme scores were generally more difficult for the computer adaptive format to estimate with as much accuracy as scores in the mid-range of the scale. However, the reduction in accuracy and sensitivity, which did not influence the group effect results in this study, is counterbalanced by the large reduction in testing burden.
The effect of lifting and lowering an external load on repositioning error of trunk flexion-extension in subjects with and without low back pain
Authors: Lin Yang Hua , Sun Ming Hui
Published: August 2006

Objective: To determine whether the repositioning error of trunk flexion-extension in individuals with low back pain is different from that in those not experiencing low back pain when lifting and lowering external loads.

Design: A case-control study.

Setting: Physical therapy department of a medical centre.

Subjects: Twenty subjects with subacute low back pain and 20 control subjects without low back pain.

Interventions: Tasks with and without lifting and lowering an external load.

Main outcome measures: The trunk repositioning errors were measured with Measurand Shape Tape.

Results: In subjects with low back pain, trunk repositioning errors were significantly reduced when lifting and lowering an external load in the direction of flexion (3.779 ±1.26 degrees in a loaded condition versus 4.82±2.97 degrees in an unloaded condition; P B< 0.05) and extension (3.17±2.15 degrees in a loaded condition versus 5.039±3.74 degrees in an unloaded condition; p < 0.05). In control subjects, trunk repositioning errors were not significantly changed when lifting and lowering an external load in the direction of flexion (2.80±1.39 degrees in a loaded condition versus 2.63±1.24 degrees in an unloaded condition; p < 0.05) and extension (2.87±1.40 degrees in a loaded condition versus 3.15±1.50 degrees in an unloaded condition; P>0.05). The direction of motion (trunk flexion or extension) was not shown to be significant in this study.

Conclusion: Performing the task whilst lifting or lowering a submaximal load showed a reduced trunk repositioning error in subjects with subacute low back pain. Lifting and lowering a submaximal load might be considered as one of the rehabilitative strategies to hasten a return to work.
Evaluation of the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS) in patients with acute stroke
Authors: Linder Annika , Winkvist Lisa , Nilsson Lena , Sernert Ninni
Published: August 2006

Objective: To investigate the inter-rater reliability and validity of the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS).

Design: A correlation study.

Setting: A stroke unit which provides acute care and rehabilitation for all stroke admissions in Northern Alvsborg County Hospital, Sweden.

Subjects: Thirty consecutive patients with an acute first-time stroke. Seventeen were women and 13 were men, with a median age of 79 years (41-92) and with a median hospital stay of 21 days (8-35).

Intervention: The patients were assessed twice with the Swe M-EMS on admission and at discharge, before and after midday, by two independent physiotherapists. They were assessed by an independent physiotherapist using the three evaluation instruments on admission, once a week during their hospital stay and at discharge.

Main outcome measures: The primary evaluation instrument was the Swe M-EMS. The two other evaluation instruments were the Modified Motor Assessment Scale of Uppsala Akademiska Sjukhus-95 (M-MAS UAS-95) and the Berg Balance Scale (BBS).

Results: The Swe M-EMS was a reliable instrument (ICC 0.98-0.99). It correlated well with both the M-MAS UAS-95 (rs=0.69-0.88) and the BBS (rs=0.86-0.94). The Swe M-EMS was sensitive to change over time, but the patients obtained the maximum score quickly.

Conclusion: The instrument shows a high inter-rater reliability. The Swe M-EMS correlates well with both the M-MAS UAS-95 and the BBS and is sensitive to change. However, it is not sensitive enough to use as a single instrument in evaluating the improvement of a patient with acute stroke.
Effects of lower limb intensive mass practice in poststroke patients: single-subject experimental design with long-term follow-up
Authors: Marklund Ingela , Klässbo Maria
Published: August 2006

Objective: To investigate the effects of two weeks of intensive mass practice with a constraint-induced movement therapy approach for the lower extremity in five chronic poststroke patients, and the persistence of effects at three and six months.

Design: A single-subject experimental design (SSED) was used with an AB design and follow-ups three and six months later.

Setting: Outpatient rehabilitation at Torsby Hospital in Sweden.

Main measures: Motor function in lower extremity, mobility, dynamic balance, weight-bearing symmetry and walking ability were measured on six occasions during two weeks (A phase), with the Fugl-Meyer assessment for lower extremity, the Timed Up and Go, the Step Test, the Timed Walking Test and the Six-Minute Walk Test. During the intervention's B phase, six measurements were performed with the same time intervals as in the A phase. There were follow-ups three and six months later.

Intervention: The intervention (B phase) consisted of bicycling, training in water, strength training, standing weight-bearing, walking up and down stairs, walking indoors and outdoors and flexibility training of the lower extremity, on all weekdays, 6 h a day for two weeks.

Results: The results showed improvements in 23/30 variables (77%), 12 of them statistically significant (52%). At follow-up, 22/23 improvements persisted. For example, three of five subjects walked significantly further after the intervention and the follow-ups showed that they still walked further than before the intervention.

Conclusion: Intensive mass practice with constraint-induced movement therapy for the lower extremity can improve motor function, mobility, dynamic balance, weight-bearing symmetry and walking ability in chronic poststroke patients.Long-term follow-up showed that the effects persisted for these five subjects.
Assessment of unilateral spatial neglect post stroke in Canadian acute care hospitals: are we neglecting neglect?
Authors: Menon-Nair Anita , Korner-Bitensky Nicol , Wood-Dauphinee Sharon , Robertson Elizabeth
Published: August 2006

Objective: To estimate the prevalence, timing and frequency of use of standardized and non-standardized assessments to detect unilateral spatial neglect in acute care patients post stroke.

Design and setting: Multicentred, retrospective study on medical charts from 10 randomly selected acute care hospitals in Ontario, Canada.

Subjects: Three hundred and twenty-four randomly selected medical charts of adult subjects with a primary diagnosis of stroke admitted in 2002 to the participating acute care hospitals.

Results: Out of 248 subjects who should have been assessed, 38% received some form of unilateral spatial neglect assessment. Only 13% were assessed with a standardized assessment and of these, 4% within 48 h post stroke or within 48 h of the patient regaining consciousness as recommended by clinical practice guidelines for stroke. Bivariate analysis found significant associations between severity of cognitive impairment and being ever assessed, as well as between the severity of motor deficits of the upper extremity and being ever assessed.

Conclusion: Routine standardized assessment of unilateral spatial neglect during the acute care phase post stroke was not incorporated into daily practice in this study sample.
The use of standardized outcome measures in rehabilitation centres in the UK
Authors: Skinner Aneetha , Turner-Stokes Lynne
Published: August 2006

Aim: To identify the standardized outcome measures currently used in routine clinical practice in rehabilitation centres in the UK.

Design: Cross-sectional survey by postal questionnaire.

Participants: All UK consultant members of the British Society of Rehabilitation Medicine (BSRM) ( n = 180).

Results: A total of 108 (60%) responses were received, representing 83 different rehabilitation services. Of these, 71 (86%) collected at least one standardized measure. The Barthel Index and the UK Functional Independence Measure and/or Functional Assessment Measure (FIM9 ± FAM) were the most popular global outcome measures: 83% of units measured one or other of these. The Northwick Park Dependency Scale (NPDS) and Care Needs Assessment (NPCNA) ( n = 21, 28%) were used for the more dependent patients. Depression and pain scores were more commonly used than general health measures. Sixty (72%) units routinely assessed outcome through the achievement of set goals, but only four transformed data to a goal attainment scale. Outcome measure scores were routinely reported in discharge summaries by 72% of units.

Conclusions: The survey demonstrated quite widespread use of outcome assessments in routine clinical rehabilitation within the UK, with an encouraging level of common measurement in some areas of practice. The results have been used to update the BSRM ‘basket of recommended measures’.
Perceived pain and satisfaction with medical rehabilitation after hospital discharge
Authors: Bergés Ivonne-Marie , Ottenbacher Kenneth J , Smith Pamela M , Smith David
Published: August 2006

Objective: To examine the association between pain and satisfaction with medical rehabilitation in patients with hip or knee replacement approximately 90 days after discharge from inpatient medical rehabilitation.

Design: A cross-sectional design.

Participants: The sample included 2507 patients with hip or knee replacement using information from the IT Health Track medical outcome database.

Main outcome measure: Satisfaction with medical rehabilitation.

Results: The average age was 70.2 years, 66.5% were female, and 88.5% were non-Hispanic white. Pain scores were significantly and inversely associated with satisfaction with medical rehabilitation after adjustment for possible confounding factors. In patients with hip replacement each one-point increase in pain score was associated with a 10% decreased odds ratio (OR) of being satisfied with medical rehabilitation (OR 0.90, 95% confidence interval (CI) 0.84, 0.96). In patients with knee replacement, each one-point increase in pain score was associated with a 9% decreased odds ratio (OR 0.91, 95% CI 0.87, 0.96) of being satisfied with medical rehabilitation.

Conclusion: Our data indicate that postoperative pain from hip or knee replacement is associated with reduced satisfaction with medical rehabilitation. Better postoperative pain control may improve a patient's level of satisfaction.
Contracture preventive positioning of the hemiplegic arm in subacute stroke patients: a pilot randomized controlled trial
Authors: de Jong L D , Nieuwboer A , Aufdemkampe G
Published: August 2006

Objective: To investigate the effectiveness of a contracture preventive positioning procedure for the hemiplegic arm in subacute stroke patients in addition to conventional physio and occupational therapy.

Design: A single-blind pilot randomized controlled trial.

Setting: Inpatient neurological units from three rehabilitation centres in the Netherlands.

Subjects: Nineteen subacute stroke patients (minus two drop-outs) with a severe motor deficit of the arm.

Interventions: All subjects underwent conventional rehabilitation care. Nine subjects additionally received a positioning procedure for two 30-min sessions a day, five days a week, for five weeks.

Main measures: Passive range of motion of five arm movements using a hydrogoniometer and resistance to passive movement at the elbow using the Ashworth Scale. Secondary outcome measures were pain at the end range of passive motions, the arm section of the Fugl-Meyer Assessment and Barthel Index scores for ADL-independence. Outcome measures were taken after five weeks and additional measurements after 10 weeks by two assessors blinded to group allocation.

Results: Comparison of the experimental ( n = 9) with the control subjects ( n = 8) after five weeks showed that additional positioning significantly slowed down development of shoulder abduction contracture ( P = 0.042, −5.3 degrees versus −23 degrees). No other differences were found between the groups.

Conclusions: Applying a contracture preventive positioning procedure for the hemiplegic arm slowed down the development of shoulder abduction contracture. Positioning did not show significant additional value on other outcome measures. Since the sample size was small, results of this study need future verification.
Relations between social support, appraisal and coping and both positive and negative outcomes for children of a parent with multiple sclerosis and comparisons with children of healthy parents
Authors: Pakenham Kenneth I , Bursnall Samantha
Published: August 2006

Objective: To examine adjustment in children of a parent with multiple sclerosis within a stress and coping framework and compare them with those who have ‘healthy’ parents.

Subjects: A total of 193 participants between 10 and 25 years completed questionnaires; 48 youngsters who had a parent with multiple sclerosis and 145 youngsters who reported that they did not have a parent with an illness or disability.

Method: A questionnaire survey methodology was used. Variable sets included caregiving context (e.g. additional parental illness, family responsibilities, parental functional impairment, choice in helping), social support (network size, satisfaction), stress appraisal, coping (problem solving, seeking support, acceptance, wishful thinking, denial), and positive (life satisfaction, positive affect, benefits) and negative (distress, health) adjustment outcomes.

Results: Caregiving context variables significantly correlated with poorer adjustment in children of a parent with multiple sclerosis included additional parental illness, higher family responsibilities, parental functional impairment and unpredictability of the parent's multiple sclerosis, and less choice in helping. As predicted, better adjustment in children of a parent with multiple sclerosis was related to higher levels of social support, lower stress appraisals, greater reliance on approach coping strategies (problem solving, seeking support and acceptance) and less reliance on avoidant coping (wishful thinking and denial). Compared with children of ‘healthy’ parents, children of a parent with multiple sclerosis reported greater family responsibilities, less reliance on problem solving and seeking social support coping, higher somatization and lower life satisfaction and positive affect.

Conclusions: Findings delineate the key impacts of young caregiving and support a stress and coping model of adjustment in children of a parent with multiple sclerosis.
Reliability and sensitivity to change of measurement instruments used in a traumatic brain injury population
Authors: van Baalen B , Odding E , van Woensel M PC , van Kessel M A , Roebroeck M E , Stam H J
Published: August 2006

Objective: To compile a minimum data set for the follow-up of traumatic brain injury patients from discharge from hospital to one year post injury to assess functioning and participation in the physical, cognitive and psychosocial domains, and in quality of life.

Design: Repeated questionnaire interviews by two observers to establish interobserver reliability of the measurement instruments at discharge and at one year post injury, as well as their sensitivity to change over time in traumatic brain injury patients.

Setting: Department of neurosurgery of an academic hospital, department of a rehabilitation centre, and at the patients' homes in the Netherlands.

Subjects: The study at discharge included 25 patients aged 18-50 years with a moderate to severe traumatic brain injury (Glasgow Coma Scale score 3-14), whereas the one year post injury study included 14 patients aged 19-51 years.

Main (outcome) measures: Physical domain: Barthel Index (BI), Functional Independence Measurement (FIM), Glasgow Outcome Scale (GOS), GOS Extended (GOSE). Cognitive domain: Disability Rating Scale (DRS), Functional Assessment Measurement (FAM), Levels of Cognitive Functioning Scale (LCFS), Neurobehavioural Rating Scale (NRS). Psychosocial domain: Community Integration Questionnaire (CIQ), Employability Rating Scale (ERS), Frenchay Activity Index (FAI), Multi Health Locus of Control (MHLC), Rehabilitation Activities Profile (RAP), Social Support List (SSL), Supervision Rating Scale (SRS), Wimbledon Self Reporting Rating Scale (WSRS). Quality of life: Coop/Wonca Charts (Coop), Rand SF-36 (Rand-36), Sickness Impact Profile-68 (SIP-68).

Results: At both discharge and at one year post injury, in the physical domainthe FIM showed excellent squared weighted kappa (SWK ranging from 0.75 to 0.80), and intraclass correlation coefficient (ICC ranging from 0.75 to 0.92), and a relatively small standard error of measurement (SEM 3.22) and smallest detectable difference (SDD 8.92). In the cognitive domain the FAM and the NRS showed excellent SWK, and ICC, and a relatively small SEM and SDD. In the psychosocial domainthe FAI showed excellent SWK (0.89), and ICC (0.87), and a relatively small SEM (2.64) and SDD (7.31). For quality of life, at both discharge and at one year post injury the SIP-68 and the Coop showed excellent SWK (0.87), and ICC (0.89), and a relatively small SEM (3.79) and SDD (10.51). At both time points SWK and ICC ranged from 0.80 to 0.89, SEM ranged from 1.47 to 1.98, and the SDD was 4.07.

Conclusions: An example of a reliable minimum data set that is also able to detect changes over time is: the FIM, the FAM and the Coop for the early stages in recovery, extended with the NRS, the FAI, and the SIP-68 later in recovery, thereby covering all relevant domains after traumatic brain injury.
The effect of botulinum toxin type A injection into the gastrocnemius muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy
Authors: Park Eun Sook , Park Chang Il , Chang Hyun Chung , Park Chan Woo , Lee Don Shin
Published: August 2006

Objective: To investigate the benefit of botulinum toxin type A injection into the ankle plantarflexor muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy.

Design: Case-control study.

Setting: Inpatients in a university-affiliated hospital.

Subjects: Forty spastic diplegic children aged from 2 to 6 years (18 children with botulinum toxin type A injection into both gastrocnemius muscles as an experimental group and 14 children without injection as a control group).

Main measures: Sit-to-stand transfer task was evaluated using a motion analyser (Vicon 370 MA with six infrared cameras). The tests were performed twice with a two-week interval. The changes in temporal, kinematic and kinetic parameters were investigated in each group.

Results: In the control group there were no significant changes in any of the measured parameters between the tests. In the experimental group, total duration (s) of sit-to-stand transfer was shortened after injection (4.359 ± 2.49 to 2.899 ± 1.48, P < 0.05). The maximal angles (degrees) of pelvic and hip joints were reduced (28.889 ± 5.53 to 26.579 ± 3.73 and 90.789 ± 8.69 to 87.239 ± 8.76) and the initial angle of ankle dorsiflexion was increased (4.419 ± 6.16 to 7.089 ± 6.09) after injection (P < 0.05). The maximal moments (Nm/kg) of the hip and knee joints (0.449 ± 0.17 to 0.519 ± 0.21 and 0.139 ± 0.05 to 0.189 ± 0.14) were increased while that of the ankle joint was reduced (0.329 ± 0.09 to 0.289 ± 0.10) after injection (P < 0.05). Only the cases with greater reduction of spasticity showed an improvement on kinematic and kinetic parameters.

Conclusion: Botulinum toxin type A injection into spastic ankle plantarflexors led to better accomplishment of sit-to-stand transfer in children with spastic diplegic cerebral palsy.
The effect of exercise of the affected foot in stroke patients-a randomized controlled pilot trial
Authors: Rydwik Elisabeth , Eliasson Sara , Akner Gunnar
Published: August 2006

Objective: To evaluate the effect of treatment with a portable device called Stimulo on range of motion, muscle strength and spasticity in the ankle joint and its effect on walking ability, balance, activities of daily living (ADL) and health-related quality of life in stroke patients.

Design: A randomized controlled pilot study.

Setting: A research centre.

Subjects: Ambulatory or partly ambulatory chronic stroke patients with remaining spasticity and/or decreased range of motion in the hemiparetic leg/ankle.

Interventions: Standardized and individualized programme including active and passive range of motion of the ankle with a portable device (Stimulo), performed three times a week for 30 min, over a six-week period.

Main measures: Range of motion, muscle strength, spasticity, gait variables, balance, ADL and health-related quality of life.

Results: Eighteen subjects were included in the study with a mean age of 75 years. The compliance rate was 94-99%. There were no significant differences between the groups.

Conclusion: The study showed no significant effect of an ankle-exercise intervention programme with Stimulo. Further studies with a larger sample size are of importance before any further conclusions can be drawn.
Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score
Authors: Foss Nicolai B , Kristensen Morten T , Kehlet Henrik
Published: August 2006

Objective: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients.

Design: Prospective, descriptive study.

Setting: An orthopaedic hip fracture unit in a university hospital.

Patients: Four hundred and twenty-six consecutive hip fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria.

Main outcome measure: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental score for cognitive dysfunction were performed. On the first three postoperative days patients were assessed with the cumulated ambulation score consisting of a cumulated assessment of simple ambulation characteristics with a score from 0 to18 (fully mobile). The three assessments were correlated to short-term outcome parameters.

Results: The cumulated ambulation score was a highly significant predictor for length of hospitalization, time to discharge status, 30-day mortality and postoperative medical complications (P < 0.001 for all). The cumulated ambulation score was superior in its association with all postoperative outcome parameters to both the New Mobility Score and the mental score. A cumulated ambulation score of ±10 correlated with a 99% survival at one month and 93% discharge to own home.

Conclusion: The cumulated ambulation score is a potentially valuable score for early prediction of short-term postoperative outcome after hip fracture surgery.
Comparison of customized versus standard exercises in rehabilitation of shoulder disorders
Authors: Wang S Sharon , Trudelle-Jackson Elaine J
Published: August 2006

Objective(s): (1) To compare the effectiveness of customized exercises with that of standard exercises for the treatment of patients with shoulder disorders. (2) To determine whether four weeks or eight weeks would be needed to see improvement in outcome measures.

Design: A single-blinded randomized clinical trial.

Setting: An outpatient physical therapy clinic affiliated with an academic institution.

Subjects: Thirty patients with shoulder disorders were tested and treated between February 2003 and December 2004.

Interventions: Patients were randomized to a customized or standard exercise group. Each patient first underwent a standardized physical therapy assessment. Based on the results of the assessment, a classification was determined and a classification-specific exercise programme was instructed to the patients in the customized exercise group. The standard exercise group, regardless of classification, received preselected standard exercises. Both groups were followed for eight weeks.

Main measures: Shoulder range of motion, strength, pain intensity and function were assessed three times (weeks 0, 4 and 8).

Results: There were no significant differences between the customized and standard exercise groups in measures of shoulder range of motion, strength, pain intensity and function after four or eight weeks of exercise. Patients in both groups had significant improvements in shoulder strength, pain intensity and function. Significant improvements occurred at week 8, but not at week 4.

Conclusion: The customized shoulder exercises did not provide additional benefit to our shoulder patients than the standard exercises.