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Pin TW, Winser SJ, Chan WLS, Chau B, Ng S, Wong T, Mak M, Pang M. Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis. J Rehabil Med 2024; 56:jrm18650. [PMID: 38226564 PMCID: PMC10802787 DOI: 10.2340/jrm.v56.18650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVES To examine the association between falls and fear of falling in people with stroke and to evaluate the differences between patients with acute stroke and those with chronic stroke with regard to any such association. METHODS Articles were searched in Medline, CINAHL, AMED, Embase, PsycINFO, Cochrane Library of Reviews and PEDro from inception until March 2023. Experimental, observational or explorative studies investigating the association between fear of falling and falls in people with stroke were included. Articles were screened by 2 independent reviewers. Data were extracted by an independent reviewer. RESULTS A total of 26 reports were included in this review (n = 2863). Fear of falling, assessed by a single-question survey, was significantly associated with falls (relative risk = 1.44; 95% confidence interval (95% CI) = 1.22, 1.70; I2 = 0%) in people with acute stroke. Significant mean differences in fear of falling, based on the Falls Efficacy Scale (mean difference = 12.80; 95% CI = 1.81, 23.78; I² = 28%) and Activities-specific Balance Confidence Scale (mean difference = -9.99; 95% CI = -15.36, -4.62; I² = 57%), were also reported between fallers and non-fallers in people with chronic stroke. CONCLUSION A small, but significant, association exists between falls and fear of falling in both acute and chronic stroke patients.
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Affiliation(s)
- Tamis W Pin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Wayne L S Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Bolton Chau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Shamay Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Thomson Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Margaret Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Marco Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Simpson MW, Mak M. Modulating Cortical Hemodynamic Activity in Parkinson's Disease Using Focal Transcranial Direct Current Stimulation: A Pilot Functional Near-infrared Spectroscopy Study. Brain Topogr 2023; 36:926-935. [PMID: 37676389 DOI: 10.1007/s10548-023-01002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
Reduced thalamocortical facilitation of the motor cortex in PD leads to characteristic motor deficits such as bradykinesia. Recent research has highlighted improved motor function following tDCS, but a lack of neurophysiological evidence limits the progress of tDCS as an adjunctive therapy. Here, we tested the hypothesis that tDCS may modulate M1 hemodynamic activity in PD and healthy using functional near-infrared spectroscopy (fNIRS). In this randomized crossover experiment, fourteen PD and twelve healthy control participants attended three laboratory sessions and performed a regulated (3 Hz) right index finger tapping task before and after receiving tDCS. On each visit, participants received either anodal, cathodal, or sham tDCS applied over M1. Hemodynamic activity of M1 was quantified using fNIRS. Significant task related activity was observed in M1 and the inferior parietal lobe in PD and healthy (p < 0.05). PD additionally recruited the dorsal premotor cortex. During tDCS, while at rest, anodal and cathodal tDCS significantly increased the oxygenated hemoglobin concentration of M1 compared to sham (t62 = 4.09 and t62 = 4.25, respectively). Task related hemodynamic activity was unchanged following any tDCS intervention (p > 0.05). Task related hemodynamic activity of M1 is not modulated by tDCS in PD or healthy. During tDCS, both anodal and cathodal stimulation cause a significant increase of M1 oxygenation, the clinical significance of which remains to be clarified.
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Affiliation(s)
- Michael W Simpson
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Margaret Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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Rahmani A, Mak M, Carney C. Efficacy of digital CBT-I smartphone applications: A systematic review of the current literature. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Yang B, Li Y, Wang F, Auyeung S, Leung M, Mak M, Tao X. Intelligent wearable system with accurate detection of abnormal gait and timely cueing for mobility enhancement of people with Parkinson's disease. Wearable Technol 2022; 3:e12. [PMID: 38486907 PMCID: PMC10936378 DOI: 10.1017/wtc.2022.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/11/2022] [Accepted: 05/25/2022] [Indexed: 03/17/2024]
Abstract
Previously reported wearable systems for people with Parkinson's disease (PD) have been focused on the detection of abnormal gait. They suffered from limited accuracy, large latency, poor durability, comfort, and convenience for daily use. Herewith we report an intelligent wearable system (IWS) that can accurately detect abnormal gait in real-time and provide timely cueing for PD patients. The system features novel sensitive, comfortable and durable plantar pressure sensing insoles with a highly compressed data set, an accurate and fast gait algorithm, and wirelessly controlled timely sensory cueing devices. A total of 29 PD patients participated in the first phase without cueing for developing processes of the algorithm, which achieved an accuracy of over 97% for off-line detection of freezing of gait (FoG). In the second phase with cueing, the evaluation of the whole system was conducted with 16 PD subjects via trial and a questionnaire survey. This system demonstrated an accuracy of 94% for real-time detection of FoG and a mean latency of 0.37 s between the onset of FoG and cueing activation. In questionnaire survey, 88% of the PD participants confirmed that this wearable system could effectively enhance walking, 81% thought that the system was comfortable and convenient, and 70% overcame the FoG. Therefore, the IWS makes it an effective, powerful, and convenient tool for enhancing the mobility of people with PD.
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Affiliation(s)
- Bao Yang
- School of Civil Engineering and Transportation, South China University of Technology, Guangzhou, China
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ying Li
- Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
| | - Fei Wang
- Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong, China
- School of Textile Materials and Engineering, Wuyi University, Jiangmen, China
| | - Stephanie Auyeung
- Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Manyui Leung
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong, China
| | - Margaret Mak
- Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoming Tao
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
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Tyburski E, Podwalski P, Mak M, Michalczyk A, Kucharska-Mazur J, Samochowiec J, Sagan L. The relationship between white matter integrity of superior longitudinal fascicle and cognitive functions in chronic schizophrenia. Eur Psychiatry 2022. [PMCID: PMC9568223 DOI: 10.1192/j.eurpsy.2022.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Some evidence suggests that disruption of integrity in the superior longitudinal fascicle (SLF) may influence cognitive functions in chronic schizophrenia (CS) but the results are inconclusive. Objectives Using diffusion tensor imaging tractography, we investigated the differences in fiber integrity between patients with CS and healthy controls (HC) together with the relationship between fiber integrity and cognitive functions. Methods Forty-two patients with CS and 32 HC took part in the study. Assessment of cognitive functions was performed using Measurement and Treatment Research to Improve Cognition in Schizophrenia. Results showed group differences, left and right in fractional anisotropy (FA) and mean diffusivity (MD) of the SLF, where patients showed less integrity than controls. Patients performed worse attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition tasks than HC. However, when premorbid IQ and level of education were controlled for, the differences were no longer statistically significant in verbal learning and social cognition. In patients with CS, a positive correlation was found between FA of the left SLF and attention/vigilance and working memory. Moreover, in this group there was a negative correlation between MD of the left and right SLF and working memory and social cognition. Conclusions These findings provide evidence that SLF disruption appears in patients with CS and might account for impairment of cognitive functioning. This research was funded by the Polish Minister of Science and Higher Education’s program named “Regional Initiative of Excellence” number 002/RID/2018/2019 to the amount of 12 million PLN. Disclosure No significant relationships.
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Simpson MW, Mak M. Single session transcranial direct current stimulation to the primary motor cortex fails to enhance early motor sequence learning in Parkinson's disease. Behav Brain Res 2022; 418:113624. [PMID: 34634239 DOI: 10.1016/j.bbr.2021.113624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Explicit motor sequence learning is impaired in Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) applied over the motor cortex in healthy can improve explicit motor learning, but comparative effects in PD are unknown. This exploratory study aims to examine the effect of single session tDCS on explicit motor sequence learning in PD. METHODS Thirty-three people with mild to moderate PD learnt a short and long finger tapping sequence with their right hand. Participants received either anodal, cathodal, or sham tDCS applied over the left primary motor cortex during task practice. Single- and dual-task finger tapping performance was assessed before and after task practice and functional near-infrared spectroscopy used to measure task related changes of oxygenated haemoglobin. RESULTS Finger tapping performance of short and long sequences under single-task conditions significantly improved following practice (p = 0.010 and p < 0.001, respectively). A condition-by-time interaction trend was observed for the long finger tapping sequence (p = 0.069) driven by improved performance in the cathodal (p = 0.001) and sham (p < 0.001) tDCS conditions, but not anodal tDCS (p = 0.198). The primary and premotor cortex and supplementary motor area were active in all tasks. No interaction or main effects were observed for task related changes of oxygenated haemoglobin. CONCLUSIONS PD patients retain the capacity to learn an explicit sequence of movements. Motor cortex tDCS does not improve explicit motor learning in PD and anodal tDCS may even suppress the rate of learning.
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Affiliation(s)
- Michael William Simpson
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Margaret Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Argiris A, Harrington K, Tahara M, Ferris R, Gillison M, Fayette J, Daste A, Koralewski P, Mesia Nin R, Saba N, Mak M, Álvarez Avitia M, Guminski A, Müller-Richter U, Kiyota N, Roberts M, Khan T, Miller-Moslin K, Wei L, Robert Haddad R. LBA36 Nivolumab (N) + ipilimumab (I) vs EXTREME as first-line (1L) treatment (tx) for recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): Final results of CheckMate 651. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mak M. SY2.5. Balance and gait assessment. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sim N, Lee S, Yap HY, Tan QY, Tan J, Wong D, Chau A, Mak M, Chong TT, Tay HT. A review of the Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe (TOPHAT) flap for wound coverage during ray amputations of the toes. Foot (Edinb) 2021; 47:101803. [PMID: 33964533 DOI: 10.1016/j.foot.2021.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/07/2021] [Accepted: 04/11/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Exposure of the adjacent Metatarsal-Phalangeal Joint (MTPJ) commonly occurs after application of Topical Negative Pressure Wound Therapy (TNPWT) for a ray amputation wound. This is due to mechanical soft tissue erosion or trauma to the adjacent digital artery from direct pressure effect. This results in toe gangrene requiring a ray amputation and ultimately a larger wound bed. We describe the use of the Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe (TOPHAT) flap - a filleted toe flap to protect the adjacent MTPJ capsule combined with a novel Negative Pressure Wound Therapy with instillation and dwell-time (NPWTi-d) dressing technique. The flap protects the adjacent joint capsule and reduces the wound burden whilst allowing the wound to benefit from TNPWT, thereby accelerating wound healing. MATERIAL AND METHODS A retrospective review was conducted of patients with toe gangrene requiring ray amputation that underwent the TOPHAT flap on in our institution from 2019 and 2020. Complications such as wound dehiscence, hematoma, flap necrosis and secondary infection were recorded. Other outcomes recorded were time taken to final skin grafting and time taken for complete wound epithelialization. RESULTS 9 patients underwent treatment with the TOPHAT flap. 2 patients had flap necrosis. 7 patients progressed to definitive skin coverage with skin grafting. One patient subsequently had progressive arterial disease despite successful skin grafting and required above knee amputation. The mean time to final skin grafting and complete wound epithelialization was 49.5 days and 107.5 days respectively. All patients were satisfied with the outcomes and were able to return to their pre-morbid function. CONCLUSIONS The TOPHAT flap has a consistent vascular supply that provides durable soft tissue coverage. It is a robust and easily reproducible technique to accelerate wound healing after ray amputations even in patients with peripheral vascular disease.
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Affiliation(s)
- N Sim
- Department of Vascular and Endovascular Surgery, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - S Lee
- Department of Vascular and Endovascular Surgery, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - H Y Yap
- Department of Vascular and Endovascular Surgery, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - Q Y Tan
- Podiatry Department, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - J Tan
- Podiatry Department, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - D Wong
- Podiatry Department, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - A Chau
- Podiatry Department, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - M Mak
- Podiatry Department, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - T T Chong
- Department of Vascular and Endovascular Surgery, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
| | - H T Tay
- Department of Vascular and Endovascular Surgery, Singapore General Hospital, Academia Level 5, Outram Road, 169608, Singapore.
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Caparica R, Amorim L, Amaral P, Uratani L, Muniz D, Hendlisz A, Glasberg J, Takahashi T, Abdo E, Saragiotto D, Sabbaga J, Mak M. 1849P Safety and effectiveness of palliative chemotherapy (CTX) for patients (pts) with malignant bowel obstruction (MBO). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Chung C, Mak M. Comparison of effect of a single-session of high- or low-frequency rTMS on cortical excitability in people with Parkinson’s disease – A randomised placebo controlled trial. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Simpson M, Mak M. The effect of transcranial direct current stimulation on motor cortex activity in Parkinson’s disease: A proof-of-principle fNIRS study. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Notaras S, Mak M, Wilson N. Advancing practice in dietitians’ communication and nutrition counselling skills: a workplace education program. J Hum Nutr Diet 2018; 31:725-733. [DOI: 10.1111/jhn.12569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- S. Notaras
- Department of Dietetics; Liverpool Hospital; Liverpool NSW Australia
| | - M. Mak
- Department of Dietetics; Liverpool Hospital; Liverpool NSW Australia
| | - N. Wilson
- Department of Dietetics; Liverpool Hospital; Liverpool NSW Australia
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Smythe K, Saw M, Mak M, Wong VW. Carbohydrate knowledge, lifestyle and insulin: an observational study of their association with glycaemic control in adults with type 1 diabetes. J Hum Nutr Diet 2018; 31:597-602. [DOI: 10.1111/jhn.12561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- K. Smythe
- Department of Dietetics; Liverpool Hospital; Liverpool Australia
| | - M. Saw
- South Western Sydney Clinical School; UNSW Australia
| | - M. Mak
- Department of Dietetics; Liverpool Hospital; Liverpool Australia
| | - V. W. Wong
- South Western Sydney Clinical School; UNSW Australia
- Liverpool Diabetes Collaborative Research Unit; Ingham Institute of Applied Medical Research; Liverpool Australia
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Abstract
BACKGROUND Following evidence suggestive of high mortality following emergency laparotomies, the National Emergency Laparotomy Audit (NELA) was set up, highlighting key standards in emergency service provision. Our aim was to compare our NHS trust's adherence to these recommendations immediately prior to, and following, the launch of NELA, and to compare patient outcome. METHODS This was a retrospective study of patients who underwent an emergency laparotomy over the course of 6 months - 3 months either side of the initiation of NELA. RESULTS There were 44 patients before the initiation of NELA (pre-NELA, PN group) and 55 in the first 3 months of NELA (N group). We saw a significant increase in the proportion of patients whose decision to operate was made by the consultant: 75.0% in the PN group vs 100% in N group (subsequent data presented in this order) (P < 0.001). The presence of a consultant surgeon (75.0% vs 83.6%, P = 0.321) and anaesthetist (100.0% vs 90.9%, P = 0.064) in theatres were comparable in both groups. Risk stratification based on Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) score showed no difference in high-risk patients in both groups (47.7% vs 36.4%, P = 0.306). With the NELA initiative, however, significantly more patients were admitted directly from theatres to the critical care unit, when compared with the pre-NELA period (9.1% vs 27.3%, P = 0.038). This also reflected a significant reduction in unexpected escalation to a higher level of care during this period (10.0% vs 0%, P = 0.036). Significantly more patients had uneventful recovery in the NELA period (52.3 vs 76.4%, P = 0.018), although there was no difference in 30-day mortality between the groups (2.3% vs 7.3%, P = 0.378). CONCLUSIONS This study demonstrated a greater degree of consultant involvement in the decision to operate during NELA. More high-risk patients have been identified preoperatively with diligent risk assessment and, hence, have been proactively admitted to critical care units following laparotomy, which may account for the significant reduction in unexpected escalation to level 2 or level 3 care and thus in overall better patient outcomes.
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Affiliation(s)
- M Mak
- Department of General Surgery, James Paget University Hospital NHS Trust , Great Yarmouth , UK
| | - A R Hakeem
- Department of General Surgery, James Paget University Hospital NHS Trust , Great Yarmouth , UK
| | - V Chitre
- Department of General Surgery, James Paget University Hospital NHS Trust , Great Yarmouth , UK
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He W, Au-Yeung SYS, Mak M, Leung TWH, Leung H, Wong LKS. The potential synergism by combining external counterpulsation with intermittent theta burst stimulation in post-stroke motor function recovery. Med Hypotheses 2016; 93:140-2. [PMID: 27372874 DOI: 10.1016/j.mehy.2016.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/22/2016] [Indexed: 11/16/2022]
Abstract
Upper limb weakness and incoordination is a common disability following ischemic stroke. Previous studies have showed that the single application of external counterpulsation (ECP) and intermittent theta burst stimulation (iTBS) can effectively enhance the cortical motor excitability and facilitate recovery. However, it remains uncertain if sequential application of these therapies would further augment the recovery. We hypothesize a synergistic effect of ECP followed by iTBS to upper limb function may happen through improvements in both cerebral perfusion and neuron excitability.
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Affiliation(s)
- Weijia He
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Margaret Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Thomas Wai Hong Leung
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; Division of Neurology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Howan Leung
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; Division of Neurology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Lawrence Ka Sing Wong
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; Division of Neurology, Prince of Wales Hospital, Shatin, Hong Kong.
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Mak M, Moulaert VRM, Pijls RW, Verbunt JA. Measuring outcome after cardiac arrest: construct validity of Cerebral Performance Category. Resuscitation 2015; 100:6-10. [PMID: 26744101 DOI: 10.1016/j.resuscitation.2015.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/01/2015] [Accepted: 12/16/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Approximately half of the survivors of cardiac arrest have cognitive impairments due to hypoxic brain injury. To describe the outcome after a cardiac arrest, the Cerebral Performance Category (CPC) is frequently used. Although widely used, its validity is still debatable. OBJECTIVE To investigate the construct validity of the Cerebral Performance Category in survivors of a cardiac arrest. Participants were 18 years and older that survived a cardiac arrest more than six months. METHODS Cross-sectional design. A method to administer the CPC in a structured and reproducible manner was developed. This 'Structured CPC' was administered by a structured interview. Construct variables were Cognitive Failure Questionnaire (CFQ), Barthel Index (BI), Frenchay Activity Index (FAI), Community Integration Questionnaire (CIQ) and Quality of Life after Brain Injury (Qolibri). Associations were tested based on Spearman correlation coefficients. RESULTS A total of 62 participants responded. In 58 (94%) patients the CPC was determined, resulting in CPC 1 (48%), CPC 2 (23%) and CPC 3 (23%). The CPC-scoring correlated significantly with the CFQ (r=-0.40); BI (r=-0.57); FAI (r=-0.65), CIQ (r=-0.53) and Qolibri (r=-0.67). DISCUSSION AND CONCLUSIONS In this study we developed the 'Structured CPC' to improve the transparency and reproducibility of the original CPC. A moderate correlation between the 'Structured CPC' and the constructs 'activities', 'participation' and 'quality of life' confirmed the validity of the 'Structured CPC'. CLINICAL MESSAGE The 'Structured CPC' can be used as an instrument to measure the level of functioning after cardiac arrest.
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Affiliation(s)
- M Mak
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands; Revant Rehabilitation Centre Breda, Brabantlaan 1, 4817 JW Breda, The Netherlands.
| | - V R M Moulaert
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands; CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - R W Pijls
- CAPHRI School for Public Health and Primary Care, Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - J A Verbunt
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands; CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
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Lo W, Ngai S, Mak M. Early integration of physiotherapy knowledge acquired into simulated acute care management. Hong Kong Physiother J 2015. [DOI: 10.1016/j.hkpj.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Greig A, Bainbridge L, Bedard-Gautrais C, Gris A, Kramer T, Mak M, St. Martin J. An evaluation of patient-centred care elements that influence patient satisfaction in physiotherapy practice: a systematic review. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jansen N, Mak M, Meijnders P, Christian N, Van den Berghe L, Hendrickx J, Hellinckx H, De Meerleer G. OC-0287: How does the general public feel about radiotherapy? Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Mak M, Yu L. P293: Effects of transcranial direct current stimulation on dual-task gait performance in patients with Parkinson’s disease. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50415-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mak M, Zaman M, Kamm R. SU-E-J-41: Computational and Experimental Analysis of Cancer Cell Mechanics in 3D: Intracellular Viscoelasticity and Internal Stresses. Med Phys 2014. [DOI: 10.1118/1.4888093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Slawek J, Roszmann A, Robowski P, Dubaniewicz M, Sitek E, Honczarenko K, Gorzkowska A, Budrewicz S, Mak M, Golab-Janowska M, Drozdzik M, Kurzawski M, Bandurski T, Bialecka M. The Impact of MRI White Matter Hyperintensities on the Dementia in Parkinson's Disease in Relation to the Homocysteine Level and Other Vascular Risk Factors (P07.126). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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25
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Shen X, Mak M. Repetitive step training with preparatory signals improves stability limits in patients with Parkinson’s disease. J Rehabil Med 2012; 44:944-9. [DOI: 10.2340/16501977-1056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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Marcinkiewicz J, Mak M, Bobek M, Biedroń R, Białecka A, Koprowski M, Kontny E, Maśliński W. Is there a role of taurine bromamine in inflammation? Interactive effects with nitrite and hydrogen peroxide. Inflamm Res 2005; 54:42-9. [PMID: 15723204 DOI: 10.1007/s00011-004-1322-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE AND DESIGN The myeloperoxidase system of neutrophils generates chlorinating and brominating oxidants in vivo. The major haloamines of the system are taurine chloramine (TauCl) and taurine bromamine (TauBr). It has been demonstrated in vitro that TauCl exerts both antiinflammatory and anti-bacterial properties. Much less is known about TauBr. The present study was conducted to compare bactericidal and immunoregulatory capacity of TauBr with that of the major chlorinating oxidants: HOCl and TauCl. Moreover, the effect of nitrites and H(2)O(2) on TauBr activity was investigated. MATERIALS TauBr was prepared by reaction of HOBr with taurine. The reaction was monitored by UV absorption spectra. METHODS Bactericidal activity of TauBr, TauCl and HOCl was tested by incubation of E. coli with the compounds and determined by the pour-plate method. To test the anti-inflammatory activity the compounds were incubated with LPS and IFN-gamma stimulated murine peritoneal macrophages. The production of following mediators was measured: nitrites by Griess reaction; TNF-alpha, IL-6, IL-10, IL-12p40 using capture ELISA. In some experiments the compounds were incubated with either nitrites or H(2)O(2). RESULTS In our experimental set-up TauBr and HOCl exerted strong bactericidal effects on E. coli (MBC = 110 microM and 8 microM, respectively), while TauCl (< 1000 microM) did not kill test bacteria. However, both, TauBr and TauCl, at noncytotoxic concentrations (< 300 microM) inhibited the cytokine and nitric oxide production by macrophages. H(2)O(2) completely abolished the biological activities of TauBr but not those of TauCl. Nitrites did not affect any activity of TauBr or TauCl while they diminished the HOCl(-) mediated bacterial killing. CONCLUSION TauBr, despite very low concentration of Br(-) in body fluids, may support TauCl and HOCl in the regulation of inflammatory response and in killing of bacteria by neutrophils. However, TauBr activity in vivo will depend on the presence of H(2)O(2) and possible other mediators of inflammation which can compete with target molecules for TauBr.
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Affiliation(s)
- J Marcinkiewicz
- Department of Immunology, Jagiellonian University Medical College, 18 Czysta St., 31-121, Craców, Poland.
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Hirji Z, O'Grady S, Bonham J, Mak M, Takata-Shewchuk J, Hawkins K, Gardam M, Law L, Mazzulli T, Conly J. Utility of zanamivir for chemoprophylaxis of concomitant influenza A and B in a complex continuing care population. Infect Control Hosp Epidemiol 2002; 23:604-8. [PMID: 12400891 DOI: 10.1086/501979] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe compliance with and the safety and prophylactic efficacy of zanamivir among patients at risk of developing influenza-related complications after exposure to both influenza A and B viruses. DESIGN Nonrandomized trial using both historical and contemporaneous controls from ward populations within the same facility. SETTING A 547-bed urban hospital providing complex continuing care and rehabiltation. PATIENTS Fifty patients on a single ward concomitantly exposed to both influenza A and B during an influenza outbreak. INTERVENTIONS All patients were screened for symptoms of influenza and nasopharyngeal swabs were sent for viral culture prior to treatment (two oral inhalations [2 x 5 mg] twice daily for 5 days) or prophylaxis (two oral inhalations [2 x 5 mg] once daily for 14 days) with zanamivir. Patient symptoms, compliance, and drug tolerance were monitored daily. Demographic data, comorbidities, vaccination status, and functional status (Katz score) were collected for all patients. RESULTS The mean age of the patients was 70.6 years (standard deviation, +/- 16.4 years). Ninety-four percent had two or more comorbidities, 71% were dependent in two or more activities of daily living, 63% had been vaccinated for influenza, and 82% had received amantadine. Zanamivir was well tolerated, with 93% of the patients completing their course. The efficacy for preventing symptomatic infection was 82% and 91% (95% confidence interval, 62% to 98%) based on historical and contemporaneous controls, respectively. CONCLUSION These data suggest that zanamivir can be used safely and effectively as a prophylactic agent in the management of influenza outbreaks in a complex continuing care population with multiple comorbidities.
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Affiliation(s)
- Z Hirji
- The Riverdale Hospital, Toronto, Ontario, Canada
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28
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Gärtner BC, Fischinger JM, Roemer K, Mak M, Fleurent B, Mueller-Lantzsch N. Evaluation of a recombinant line blot for diagnosis of Epstein-Barr Virus compared with ELISA, using immunofluorescence as reference method. J Virol Methods 2001; 93:89-96. [PMID: 11311347 DOI: 10.1016/s0166-0934(00)00301-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A commercial line blot using recombinant antigens was compared with a commercial ELISA and 'in-house' IFA (reference test). Two panels were evaluated: Panel A was selected to distinguish between primary infections (89), past infections (20) and seronegatives (8) in immunocompetent individuals. In panel B, patients with a high number of reactivations were included: immunosuppressed patients (37), lymphoma (19), nasopharyngeal carcinoma (10), chronic fatigue syndrome (14). Blood donors (43) and cross-reactive sera (29) were added as controls. Line blot and IFA were concordant in 94% of primary infections, 100% of seronegatives and 100% of past infections, similar to ELISA. Results differed significantly with regard to reactivations. When compared with IFA, the incidence of reactivations was overestimated by the blot, 24 and 58% in blood donors and cross-reactive sera, respectively. ELISA showed a similar problems with 21 and 34% indeterminate results, respectively. The line blot is easy to carry out, has a good concordance with the reference IFA for primary infections, and is, therefore, a sufficient choice for distinguishing primary infection from seronegative and past infection. EBV reactivation assessment will require other methods such as EBV viral load.
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Affiliation(s)
- B C Gärtner
- Department of Virology, University of Homburg/Saar, Kirrbergerstr. Haus 47, D-66421 Hombury Saar, Germany
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29
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Hirji Z, O'Grady S, Bonham J, Mak M, Takata-Shewchuk J, Hawkins K, Gardam M, Law L, Mazzulli T, Conly J. Utility of zanamivir for chemoprophylaxis of concomitant influenza A and B in a complex continuing-care population. Can Commun Dis Rep 2001; 27:21-4. [PMID: 11227819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- Z Hirji
- Department of Microbiology, Toronto Medical Laboratories and the University of Toronto
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30
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Buisson M, Fleurent B, Mak M, Morand P, Chan L, Ng A, Guan M, Chin D, Seigneurin JM. Novel immunoblot assay using four recombinant antigens for diagnosis of Epstein-Barr virus primary infection and reactivation. J Clin Microbiol 1999; 37:2709-14. [PMID: 10405428 PMCID: PMC85323 DOI: 10.1128/jcm.37.8.2709-2714.1999] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A new immunoblot assay, composed of four Epstein-Barr virus (EBV)-encoded recombinant proteins (virus capsid antigen [VCA] p23, early antigen [EA] p138, EA p54, and EBNA-1 p72), was compared with an immunofluorescence assay on a total of 291 sera. The test was accurate in 94.5% of cases of primary EBV infection, while an immunoglobulin G anti-VCA p23 band with strong intensity correlated with reactivation.
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Affiliation(s)
- M Buisson
- Laboratoire de Virologie Médicale Moléculaire, RHAP-CNRS, Faculté de Médecine, 38043 Grenoble, France.
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31
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Affiliation(s)
- L Balaspiri
- Department of Medical Chemistry, A. Szent-Gyorgyi Medical University, Szeged, Hungary
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32
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Mak M, Qualtrough AJ, Burke FJ. The effect of different ceramic materials on the fracture resistance of dentin-bonded crowns. Quintessence Int 1997; 28:197-203. [PMID: 9452687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This in vitro study investigated the fracture resistance of dentin-bonded crowns constructed from four ceramic materials: feldspathic porcelain, aluminous porcelain, a glass-ceramic core material (Dicor), and a leucite-enriched ceramic (Empress). Forty sound maxillary premolar teeth were chosen and divided at random into four equal groups. The teeth were prepared with a standardized crown minimal preparation. The restored teeth were subjected to compressive loading. When the mode of fracture of the specimens was examined, it was found that four mode V (severe) fractures occurred in the Empress group, compared with none in the aluminous porcelain group and one each in the feldspathic porcelain and Dicor groups. Statistical analysis indicated that the loads required to fracture Dicor specimens were significantly greater than those required to fracture the feldspathic and aluminous porcelain crowns but were not significantly different from the loads achieved by the Empress specimens.
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Affiliation(s)
- M Mak
- University Dental Hospital of Manchester, England
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Krewson CE, Dause R, Mak M, Saltzman WM. Stabilization of nerve growth factor in controlled release polymers and in tissue. J Biomater Sci Polym Ed 1997; 8:103-17. [PMID: 8957707 DOI: 10.1163/156856296x00183] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We have studied the release of nerve growth factor (NGF), a protein under consideration for treatment of Alzheimer's Disease, from polymer matrices and microspheres to characterize the stability of NGF, the dynamics of NGF release, and the distribution of NGF within the brain interstitium. Poly(ethylene-co-vinyl acetate) (EVAc) disks and poly(L-lactic acid) (PLA) microspheres were formed by codispersing NGF with one of a variety of molecules. The mass of mouse NGF (mNGF) detected following release from EVAc disks into buffered saline varied five-fold over the range of codispersants studied, with carboxymethyldextran providing optimal release, while the mass of recombinant human NGF (rhNGF) released varied four-fold from both EVAc disks and PLA microspheres, with albumin and carboxymethyldextran providing optimal release. Variation of the codispersant species significantly affected NGF release into buffered saline; it also had a noticeable, but small, effect of the amount of NGF found in the brain tissue following implantation of a polymer device. To improve NGF retention in tissue, NGF was conjugated to 70,000 molecular weight dextran and incorporated into a polymeric device. The distribution of NGF was enhanced by conjugation; comparison of NGF concentrations in the brain to a mathematical model of diffusion and elimination suggested that the elimination rate of NGF-dextran conjugate in the tissue was over seven times slower than the elimination rate of NGF. These results indicate that variation of the properties of the controlled release system may be useful in regulating the time course of NGF delivery to tissue, and that modification of the NGF itself can improve penetration and retention in the brain.
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Affiliation(s)
- C E Krewson
- Department of Chemical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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34
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Aweeka FT, Kwong M, Mak M, al-Uzri A, Affrime M, Cutler D, Kahn J, Gambertoglio JG. Pharmacokinetics of recombinant human granulocyte-macrophage colony-stimulating factor: the effects of zidovudine. J Clin Pharmacol 1996; 36:1107-13. [PMID: 9013366 DOI: 10.1002/j.1552-4604.1996.tb04163.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recombinant human granulocyte-macrophage colony-stimulating factor (rHu GM-CSF) enhances bone marrow production of and stimulates granulocytes, macrophages, and eosinophils. Granulocyte-macrophage colony-stimulating factor may be used concomitantly with zidovudine in human immunodeficiency virus (HIV)-positive patients to minimize zidovudine-associated neutropenia. This open-label, randomized, placebo-controlled study was performed to evaluate the pharmacokinetic disposition of rHu GM-CSF in HIV-positive, asymptomatic patients in the absence and presence of concomitant zidovudine administration. Eight participants received rHu GM-CSF (5 micrograms/kg subcutaneously) daily for 4 days in combination with placebo or zidovudine (200 mg orally every 8 hours) in a randomized, crossover fashion, with each study period separated by a 3-day washout phase. Pharmacokinetic blood sampling was performed over 16 hours on days 1 and 4 of both treatment periods, and subsequent analysis of serum was performed using an enzyme-linked immunosorbent assay. Pharmacokinetic results of rHu GM-CSF at steady state (days 4 of periods I and II) in the absence (placebo) and presence of zidovudine included apparent total body clearance, half-life, and apparent volume of distribution, all of which were not significantly altered with concomitant administration of zidovudine. Mean pharmacokinetic results of rHu GM-CSF after the first dose (days 1 of periods I and II) were similar to steady-state values; however, total body clearance was significantly increased at steady state compared with the results of the first dose. Concurrent administration of zidovudine does not influence the pharmacokinetic disposition of rHu GM-CSF after single or multiple doses.
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Affiliation(s)
- F T Aweeka
- Department of Clinical Pharmacy, University of California, San Francisco 94143-0622, USA
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35
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Abstract
Intracranial controlled release polymers have been used for drug delivery to the brain, bypassing the blood brain barrier (BBB). By understanding the rates and patterns of transport in the local tissues, it is possible to design delivery systems that provide the optimal spatial and temporal pattern of chemotherapy within the intracranial space. This paper reviews the kinetics of drug release from polymeric controlled release implants, and describes the fate of drug molecules following release into the brain interstitium. Potential improvements in drug delivery based on the understanding of the mechanisms of drug release, transport and elimination are discussed.
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Affiliation(s)
- M Mak
- Department of Chemical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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Abstract
1. Experience from scale validation studies and from controlled drug trials provided clues for optimalisation of studies in aggressive patients. 2. Definitions of target behaviour, selection of patients and measurement of aggression are reviewed and recommendations are presented.
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Affiliation(s)
- M Mak
- Clinical Pharmacology Department, Solvay Duphar, The Netherlands
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37
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Aweeka FT, Mak M, al-Uzri A, Peter K, Dett C, Franco J, Affrime M, Guerciolini R, Cutler DL, Kahn J. Oral and intravenous zidovudine pharmacokinetics: the effect of granulocyte-macrophage colony stimulating factor. J Clin Pharmacol 1995; 35:856-64. [PMID: 8786245 DOI: 10.1002/j.1552-4604.1995.tb04130.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Combination therapy with zidovudine and recombinant human granulocyte-macrophage colony stimulating factor (rHu GM-CSF) may be warranted, owing to the bone marrow suppressive effects of zidovudine. A study of 16 patients, 8 of whom had acquired immune deficiency syndrome (AIDS) and 8 of whom were infected with human immunodeficiency virus (HIV) but were asymptomatic, was conducted. The effect of 4 days of rHU GM-CSF versus placebo on intermittent zidovudine therapy (200 mg every 8 hours) was evaluated using a randomized, cross-over study design. Pharmacokinetics of oral and intravenous zidovudine were determined on days 1 (oral), 3 (oral), and 4 (intravenous) of rHu-GM-CSF (placebo) administration. After intravenous dosing, zidovudine plasma clearance for placebo and rHu GM-CSF averaged 1.4 +/- 0.2 and 1.3 +/- 0.2 L/hr/kg, respectively (P = 0.017), mean residence time averaged 1.5 +/- 0.5 and 1.9 +/- 0.6 hours, respectively (P = 0.012), and the steady-state volume of distribution was 2.0 +/- 0.7 and 2.3 +/- 0.7 L/kg, respectively (P = 0.027) for the two treatment arms. Stratified data for patients with AIDS and those with asymptomatic HIV infection revealed no significant difference in plasma clearance or mean residence time between the two patient groups. These pharmacokinetic results indicate that dosage adjustments for zidovudine are not warranted when administered with rHu GM-CSF owing to the small changes observed. However, the statistically significant increase in Vss suggests the possibility of enhanced zidovudine cellular uptake in the presence of rHu GM-CSF.
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Affiliation(s)
- F T Aweeka
- Division of Clinical Pharmacy, University of California, San Francisco, USA
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38
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de Koning P, Mak M, de Vries MH, Allsopp LF, Stevens RB, Verbruggen R, Van den Borre R, van Peteghem P, Kohen D, Arumainayagam M. Eltoprazine in aggressive mentally handicapped patients: a double-blind, placebo- and baseline-controlled multi-centre study. The Eltoprazine Aggression Research Group. Int Clin Psychopharmacol 1994; 9:187-94. [PMID: 7814828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The efficacy of eltoprazine, a mixed 5-HT1 agonist, in treating aggressive behaviour in mentally handicapped patients was evaluated in a double-blind, placebo- and baseline-controlled study. In the total sample of 160 patients who entered the 8 week double-blind treatment phase, efficacy was not demonstrated. Also in a 28 week double-blind follow-up study, efficacy could not be demonstrated. Post-hoc exploratory analyses suggested eltoprazine was significantly better than placebo in reducing aggression scores of a subgroup of severely aggressive patients. There was no evident relationship between the plasma level of eltoprazine and therapeutic effect or safety and tolerance. The overall safety and tolerance of chronic eltoprazine treatment was good. In the discussion, several issues and pitfalls of aggression research are dealt with.
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Affiliation(s)
- P de Koning
- Department of Clinical Pharmacology, Solvay Duphar BV, Weesp, The Netherlands
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Affiliation(s)
- B Olivier
- CNS-Research, Drug Discovery Section, Solvay Duphar b.v., Weesp, The Netherlands
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Abstract
We have measured the changes in VO2 and the VO2:DO2 relationship during infusion of dobutamine in healthy volunteers. Nine healthy, adult, non-obese, male physicians were infused with an incremental infusion of dobutamine starting at 2.5 micrograms kg-1 min-1 increasing to 5.0 and then 7.5 micrograms kg-1 min-1 for 15 min each. VO2 and cardiac index were measured every five minutes. VO2I (VO2m-2) increased from a baseline of 128 (SEM 6.1) ml min-1 m-2 to 159 (8.0) ml min1 m-2 (P < 0.05) at the end of infusion with 7.5 micrograms kg-1 min-1. The corresponding changes for DO2I (DO2 m-2) were from 643 (35) ml min-1 m-2 to 1240 (142) ml min-1 m-2 (P < 0.05). The coefficient of correlation for pairs of VO2 and DO2 values, at baseline and each dobutamine infusion in individual subjects, ranged from 0.89 to 0.99 (mean 0.95, SD 0.03). Dobutamine has potent calorigenic effects; demonstration of a positive correlation between VO2 and DO2 after infusion of dobutamine does not necessarily imply an underlying tissue oxygen debt.
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Affiliation(s)
- S B Bhatt
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, NT
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41
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Suckau D, Mak M, Przybylski M. Protein surface topology-probing by selective chemical modification and mass spectrometric peptide mapping. Proc Natl Acad Sci U S A 1992; 89:5630-4. [PMID: 1608973 PMCID: PMC49346 DOI: 10.1073/pnas.89.12.5630] [Citation(s) in RCA: 161] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aminoacetylation of lysine residues and the modification of arginine by 1,2-cyclohexanedione to N7,N8-(dihydroxy-1,2-cyclohexylidene)arginine were used for probing the surface topology of hen-eggwhite lysozyme as a model protein. The molecular identification of lysine and arginine modification sites was provided by molecular weight determinations of modified and unmodified tryptic peptide mixtures (peptide mapping) using 252Cf plasma desorption mass spectrometry. At conditions of limited chemical modification, mass-spectrometric peptide-mapping analyses of lysozyme derivatives enabled the direct assignment of relative reactivities of lysine and arginine residues at different reaction times and reagent concentrations. The relative reactivities of lysine residues showed a direct correlation with their surface accessibilities from x-ray structure data. For the reaction with 1,2-cyclohexanedione, a selective modification at Arg-5, -125, -112, and -73 was identified, and an inverse correlation of relative reactivities with the surface accessibility ratios of the N7- and the N8-guanidino functions was obtained. By examination of the x-ray structural data of lysozyme, this selective modification was attributed to intramolecular catalysis because of the presence of neighboring proton acceptor groups, such as the Asp-119 carboxylate group for Arg-125 and the Trp-123 and Arg-125 carbonyl groups for Arg-5.
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Affiliation(s)
- D Suckau
- Fakult"at f"ur Chemie, Universit"at Konstanz, W-7750 Konstanz, Federal Republic of Germany
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42
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de Koning P, Mak M. Problems in human aggression research. J Neuropsychiatry Clin Neurosci 1991; 3:S61-5. [PMID: 1821224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- P de Koning
- Clinical Research Department, Duphar B.V., Weesp, The Netherlands
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Raghoebar M, Mak M, Cournot A, Pistorius MC, Van Harten J, Roseboom H. Pharmacokinetics of eltoprazine in healthy male subjects after single dose oral and intravenous administration. Br J Clin Pharmacol 1990; 30:879-83. [PMID: 2288834 PMCID: PMC1368309 DOI: 10.1111/j.1365-2125.1990.tb05454.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The kinetics, safety and tolerability of eltoprazine hydrochloride were studied in an open, cross-over, partially randomised design after single oral (8 mg) and intravenous (3 and 8 mg) doses to 12 healthy male subjects. After intravenous administration, the mean t1/2 ranged from 7 to 9 h, the MRT was 11 h, CL was 487 +/- 148 (3 mg dose) and 471 +/- 56 (8 mg dose) ml kg-1 h-1, while CLR was 226 +/- 124 (3 mg dose) and 189 +/- 38 (8 mg dose) ml kg-1 h-1. The Vss was 3.3 +/- 0.7 (3 mg dose) and 3.8 +/- 0.5 (8 mg dose) 1 kg-1. Cumulative renal excretion was 40%. The AUC and the cumulative urinary excretion were directly proportional to dose within the range of 3-8 mg. Values of tmax varied from 1 to 4 h after oral administration. The mean Cmax value was 24 ng ml-1 after an oral dose of 8 mg. The plasma elimination half-life after oral administration was 9.8 +/- 3.9 h. Absolute oral bioavailability was 110 +/- 32%. Dose-dependent somnolence was observed.
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Affiliation(s)
- M Raghoebar
- Department of Drug Disposition, Duphar B.V., DA Weesp.,The Netherlands
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Raouf A, Morooka K, Mak M. An experimental study of discrete asymmetrical simultaneous hand motions in a horizontal plane. J Hum Ergol (Tokyo) 1981; 10:125-37. [PMID: 7052212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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