Cancer screening in prisons: lessons for health providers

BACKGROUND

Lifestyle factors place those who experience incarceration at increased risk of morbidity and mortality from a range of preventable diseases, including cancer.

METHODS

Two nurses were employed for a period of 6months to facilitate bowel and breast cancer screening of prisoners across four correctional centres in Queensland. We identify factors impacting on cancer screening in prisons and document the outcomes for those screened.

RESULTS

Both screening programs produced a positivity rate of ∼17% in those screened, with 23 individuals returning a positive faecal occult blood test and five women requiring further investigations following breast screening. At 3months postscreening, all of the positive cases had been referred for further investigations. It is likely that the screening programs were instrumental in preventing morbidity (and mortality) in the subgroup with positive test results.

CONCLUSIONS

Cancer screening within the prison environment presents a number of challenges. Intervention at the individual and systems level is required to ensure prisoners can access a standard of care equal to that provided in the community.

Peroxisomal very long-chain fatty acid transport is targeted by herpesviruses and the antiviral host response

Very long-chain fatty acids (VLCFA) are critical for human cytomegalovirus replication and accumulate upon infection. Here, we used Epstein-Barr virus (EBV) infection of human B cells to elucidate how herpesviruses target VLCFA metabolism. Gene expression profiling revealed that, despite a general induction of peroxisome-related genes, EBV early infection decreased expression of the peroxisomal VLCFA transporters ABCD1 and ABCD2, thus impairing VLCFA degradation. The mechanism underlying ABCD1 and ABCD2 repression involved RNA interference by the EBV-induced microRNAs miR-9-5p and miR-155, respectively, causing significantly increased VLCFA levels. Treatment with 25-hydroxycholesterol, an antiviral innate immune modulator produced by macrophages, restored ABCD1 expression and reduced VLCFA accumulation in EBV-infected B-lymphocytes, and, upon lytic reactivation, reduced virus production in control but not ABCD1-deficient cells. Finally, also other herpesviruses and coronaviruses target ABCD1 expression. Because viral infection might trigger neuroinflammation in X-linked adrenoleukodystrophy (X-ALD, inherited ABCD1 deficiency), we explored a possible link between EBV infection and cerebral X-ALD. However, neither immunohistochemistry of post-mortem brains nor analysis of EBV seropositivity in 35 X-ALD children supported involvement of EBV in the onset of neuroinflammation. Collectively, our findings indicate a previously unrecognized, pivotal role of ABCD1 in viral infection and host defence, prompting consideration of other viral triggers in cerebral X-ALD.

M1 muscarinic acetylcholine receptors: A therapeutic strategy for symptomatic and disease-modifying effects in Alzheimer's disease?

The M1 muscarinic acetylcholine receptor (mAChR) plays a crucial role in learning and memory processes and has long been identified as a promising therapeutic target for the improvement of cognitive decline in Alzheimer's disease (AD). As such, clinical trials with xanomeline, a mAChR orthosteric agonist, showed an improvement in cognitive and behavioral symptoms associated with AD. Despite this, the clinical utility of xanomeline was hampered by a lack of M1 receptor selectivity and adverse cholinergic responses attributed to activation of peripheral M2 and M3 mAChRs. More recently, efforts have focused on developing more selective M1 compounds via targeting the less-conserved allosteric binding pockets. As such, positive allosteric modulators (PAMs) have emerged as an exciting strategy to achieve exquisite selectivity for the M1 mAChR in order to deliver improvements in cognitive function in AD. Furthermore, over recent years it has become increasingly apparent that M1 therapeutics may also offer disease-modifying effects in AD, due to the modulation of pathogenic amyloid processing. This article will review the progress made in the development of M1 selective ligands for the treatment of cognitive decline in AD, and will discuss the current evidence that selective targeting of the M1 mAChR could also have the potential to modify AD progression.

Automatisierte motorische Rehabilitation nach Schlaganfall

Der Artikel bietet einen Überblick über die junge Forschungsrichtung der automatisierten motorischen Rehabilitation nach Schlaganfall. Der Einsatz intelligenter Maschinen zielt auf eine Steigerung der Therapieintensität, eine Entlastung der Therapeuten und die Gewährung einer nachvollziehbaren und auf die individuellen Bedürfnisse abgestimmten Therapie. Beispiele im Bereich der oberen Extremität sind der “MIT-Manus” und der “MIME”-Roboter für eine ungehinderte Schulter-Ellenbogenbewegung in der Horizontalen, der “Bi-Manu-Track” für das bilaterale, passive und aktive Üben einer Unterarmdrehund Handgelenkscharnierbewegung, und das “Nudelholz” für die Eigentherapie einer dreidimensionalen Bewegung in der Klinik oder zu Hause. In der Gangrehabilitation werden der “Lokomat®” als angetriebenes Exoskeleton in Verbindung mit dem Laufband sowie der elektromechanische Gangtrainer “GT I” als Modell mit angetriebenen Fußplatten verwandt. Klinische Studien zu den einzelnen Geräten werden mit aufgeführt.

Maternal immune activation results in complex microglial transcriptome signature in the adult offspring that is reversed by minocycline treatment

Maternal immune activation (MIA) during pregnancy has been linked to an increased risk of developing psychiatric pathologies in later life. This link may be bridged by a defective microglial phenotype in the offspring induced by MIA, as microglia have key roles in the development and maintenance of neuronal signaling in the central nervous system. The beneficial effects of the immunomodulatory treatment with minocycline on schizophrenic patients are consistent with this hypothesis. Using the MIA mouse model, we found an altered microglial transcriptome and phagocytic function in the adult offspring accompanied by behavioral abnormalities. The changes in microglial phagocytosis on a functional and transcriptional level were similar to those observed in a mouse model of Alzheimer's disease hinting to a related microglial phenotype in neurodegenerative and psychiatric disorders. Minocycline treatment of adult MIA offspring reverted completely the transcriptional, functional and behavioral deficits, highlighting the potential benefits of therapeutic targeting of microglia in psychiatric disorders.

[Evaluation of practices in the management of scabies in children]

BACKGROUND

Scabies has been on the rise in France in recent years and has posed therapeutic problems, mainly due to the withdrawal of benzyl benzoate. The objective of this study was to describe prescribing practices for scabies in children.

METHODS

A national survey was conducted by means of a standardized questionnaire covering various clinical situations of scabies and the drugs used preferentially according to age, which was sent out between December 2014 and March 2015 to members of the clinical research group of the French Society of Paediatric Dermatology.

RESULTS

Of the 38 experts contacted, 20 replied. For a typical case of scabies, 55% of the experts initially prescribed oral ivermectin for children aged 6 years, 15% prescribed ivermectin in children aged 2 years, and 5% in infants aged 3 months. Ivermectin was more widely prescribed after failure of prior treatment or recurrence of scabies, on skin lesions or impetigo, if precarious, especially for profuse hyperkeratotic scabies. A total of 35% of the experts reported no prescribing restrictions with regard to patient age or weight. Discrepancies were observed concerning the mode of administration and the time between consecutive doses. Esdepallethrin remained the preferred local treatment among the experts (38% of all topical prescriptions) except in asthmatic children, while permethrin was the least-prescribed topical agent.

DISCUSSION

This study confirms the heterogeneity of our practices. Formal expert recommendations are awaited, particularly concerning the use of ivermectin in infants.

Emotional eating and in vivo norepinephrine transporter availability in obesity: A [11 C]MRB PET pilot study

OBJECTIVE

Emotional eating (EE) has been linked to norepinephrine dysfunction. Therefore, we aimed to investigate the relationship between EE and norepinephrine transporter (NET) availability.

METHOD

Ten severely obese individuals (body mass index (BMI) 42.4 ± 3.7 kg/m² ) and ten non-obese, healthy controls (BMI 23.9 ± 2.5 kg/m² ) matched for age and sex were studied using (S,S)-[¹¹ C]-O-methylreboxetine ([¹¹ C]MRB) positron emission tomography (PET). Kinetic modeling of regional tissue time activity curves was performed using multilinear reference tissue model 2 (MRTM2, with the occipital cortex as a reference region) to estimate binding potential based on individual PET-MR coregistration. To test for associations of EE and NET availability, participants completed the EE subscale of the Dutch Eating Behavior Questionnaire before scanning.

RESULTS

Obese individuals and non-obese, healthy controls did not significantly differ regarding EE scores and regional NET availability. For obese individuals only, correlative data analyses pointed to a sinoidal distribution pattern as a higher degree of EE related to lower NET availability in the locus coeruleus and to higher NET availability in the left thalamus.

DISCUSSION

These results indicate that central in vivo NET availability is altered in EE of individuals with obesity. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:152-156).

[Skin tumors in children]

The presence of a congenital or acquired cutaneous lesion is a frequent reason for consultation in pediatric plastic surgery unit. The management of these lesions requires a good knowledge of specific diagnoses in children. This step is sometimes difficult because of the multiplicity of possible diagnosis. Some skin tumors may be the external sign of a general disease or an underlying malformation; those can change the overall prognosis and management and require to be properly identified. The decision of surgical excision depends on various criteria, including diagnosis but also the reconstruction possibilities. The timing of surgical treatment depends on the medical emergency of the tumor resection (benign tumor, spontaneously regressive tumor, risk of degeneration into malignancy), on the cosmetic and psychological impact but also on the growth or learning steps in child life. This article first provides an aid in the diagnosis of the most common or more characteristic skin tumors. The algorithm is principally based on the pigmentation aspect of the tumor. The age and conditions of the surgical management are specified for each type of tumor. Cutaneous hemangiomas and vascular malformations, and congenital cysts and fistulas are not reported in this article.

The Influence of Treadmill Inclination on the Gait of Ambulatory Hemiparetic Subjects

Introduction. This study evaluated the influence of the degree of treadmill belt inclination for training of ambulatory patients with hemiparetic stroke.

Methods. Twelve patients were instructed to walk at 5 different levels of inclination (0%-8%) while harness-secured on the treadmill. The gait velocity was kept constant during all conditions. Dependent variables were heart rate, gait cycle-dependent parameters, and electromyographic activation patterns of the weight-bearing muscles.

Results. Heart rate increased across all inclination levels, stride length increased and cadence decreased, whereas swing symmetry improved due to shortening of the relative swing phase of the affected side at the 6% and 8% inclination levels. No change in the activation pattern of the leg muscles was found.

Conclusion. An inclination up to at least 8% can be accommodated for treadmill training by ambulatory stroke patients. For a given belt speed, heart rate increased without exceeding critical levels and patients walked with a more symmetric pattern. This protocol appeared to be safe in this selected group of subjects.

Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial

Objective: To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone.

Design: Randomized controlled trial.

Setting: Rehabilitation unit.

Subjects: Fifty patients, first-time supratentorial stroke, stroke interval less than six weeks, Barthel Index (0 / 100) from 50 to 80, able to walk a minimum distance of 12 m with either intermittent help or stand-by while walking, cardiovascular stable, minimum 50 W in the bicycle ergometry, randomly allocated to two groups, A and B.

Interventions: Group A 30 min of treadmill training, harness secured and minimally supported according to patients' needs, and 30 min of physiotherapy, every workday for six weeks, speed and inclination of the treadmill were adjusted to achieve a heart rate of HR: (Hrmax / HRrest)*0.6 / HRrest; in group B 60 min of daily physiotherapy for six weeks.

Main outcome measures: Primary outcome variables were the absolute improvement of walking velocity (m/s) and capacity (m), secondary were gross motor function including walking ability (score out of 13) and walking quality (score out of 41), blindly assessed before and after the intervention, and at follow-up three months later.

Results: Patients tolerated the aerobic training well with no side-effects, significantly greater improvement of walking velocity and capacity both at study end (p / 0.001 versus p / 0.002) and at follow-up (p < 0.001 versus p<0.001) in the experimental group. Between weeks 0 and 6, the experimental group improved walking speed and capacity by a mean of.31 m/s and 91 m, the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18, the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m, the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time.

Conclusions: Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity. The treatment approach is recommended in patients meeting the inclusion criteria. A multicentre trial should follow to strengthen the evidence.

Technical aids in hemiparetic patients: prescription, costs and usage

Objective: The purpose of the study was to document the amount and sorts of technical aids prescribed for hemiparetic stroke patients treated within a one-year period in a German rehabilitation centre.

Design: A retrospective study checking the medical records, and sending a questionnaire asking for level of satisfaction with the use of technical aids, frequency of use, punctuality of delivery, and cost coverage to patients after discharge.

Setting: A department of a neurological rehabilitation clinic (Klinik Berlin) in Germany.

Subjects: All stroke patients treated in one year.

Results: The medical records of 466 patients were checked: 194 (42%) of them received at least one technical aid with a mean of 2.1 items per person, totalling ECU 690 per person. These 194 patients were sent questionnaires at home six to ten months after discharge: 121 (62.3%) questionnaires were returned. Ninety-four patients used their technical aids regularly, 19 occasionally and eight had abandoned usage of wheelchairs and orthoses due to improvement in gait ability and/or poor fit. Eighty-five per cent of patients had a satisfaction level of over 50%. Except for lightweight wheelchairs, technical aids were delivered in time according to patients' estimations, and in most cases costs were fully covered by the regular health insurance (some private insurance schemes do not cover the (full) costs of certain technical aids). Compared with other countries, fewer technical aids were prescribed and fewer home visits (n = 23) were conducted.

Conclusion: The data provide useful information for health care planning and support the need for future prescription of technical aids to consider not only the ability of the user, but also the living environment and, where relevant, the ability of carers. In this regard more home visits could probably increase the efficient provision of technical aids and subsequently produce a higher level of satisfaction from the users.

Sex differences in serotonin-hypothalamic connections underpin a diminished sense of emotional well-being with increasing body weight

BACKGROUND/OBJECTIVES

The neurobiological mechanisms linking obesity to emotional distress related to weight remain largely unknown.

PARTICIPANTS/METHODS

Here we combined positron emission tomography, using the serotonin transporter (5-HTT) radiotracer [(11)C]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile, with functional connectivity magnetic resonance imaging, the Beck Depression Inventory (BDI-II) and the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite) to investigate the role of central serotonin in the severity of depression (BDI-II), as well as in the loss of emotional well-being with body weight (IWQOL-Lite).

RESULTS

In a group of lean to morbidly obese individuals (n=28), we found sex differences in the 5-HTT availability-related connectivity of the hypothalamus. Males (n=11) presented a strengthened connectivity to the lateral orbitofrontal cortex, whereas in females (n=17) we found strengethened projections to the ventral striatum. Both regions are known as reward regions involved in mediating the emotional response to food. Their resting-state activity correlated positively to the body mass index (BMI) and IWQOL-Lite scores, suggesting that each region in both sexes also underpins a diminished sense of emotional well-being with body weight. Contrarily to males, we found that in females also the BDI-II positively correlated with the BMI and by trend with the activity in ventral striatum, suggesting that in females an increased body weight may convey to other mood dimensions than those weight-related ones included in the IWQOL-Lite.

CONCLUSIONS

This study suggests sex differences in serotonin-hypothalamic connections to brain regions of the reward circuitry underpinning a diminished sense of emotional well-being with an increasing body weight.

[Therapeutic failure in scabies: An observational study]

BACKGROUND

Several sources suggest an escalation of scabies in France.

AIM

To describe a population of patients continuing to present with scabies despite multiple treatments in order to identify factors associated with persistence of infection.

PATIENTS AND METHODS

A descriptive cross-sectional study in adults and children consulting for persistent scabies despite at least one previous treatment. A standardized questionnaire explored potential sources of treatment failure.

RESULTS

Thirty-one patients were analyzed. Initial symptoms were noted to have started between two and 52 weeks earlier (mean: 19 weeks). The mean number of prior consultations with a general practitioner was 3.1 (0-10) and 1.7 with a dermatologist (0-7). The mean number of patients per household was 3.5 (1-9). At least one dose of oral ivermectin (maximum of 6 doses per household) was prescribed for 84 % of patients (29 % of whom were not fasted at the time). Further, 74 % of patients received at least one local application of esdepallethrin and piperonyl butoxide (maximum: 5 courses), four received benzyl benzoate and two received permethrin; however, 58 % did not reapply the substance after hand washing. All households bought the prescribed treatments despite the costs. Close contacts of patients were treated in 58 % of households. Decontamination of bedding and clothing was carried out properly in 90 % of households.

DISCUSSION

Persistence of infection appears to be linked to: (1) insufficient treatment of close contacts; (2) absence of a second treatment between days 7 and 14; (3) insufficient efficacy of the available treatments, doubtless due to multiple factors (intrinsic resistance of Sarcoptes, failure to repeat treatment, poor explanation of methods for dosing and application, and oral intake of treatments). Access to non-reimbursed treatments was not identified as a problem and decontamination of bedding and clothing was correctly performed in most cases.

CONCLUSION

Though certain fundamental aspects of scabies treatment must be better known, longer consultations and provision of efficacious treatments are also a priority.

The central nervous norepinephrine network links a diminished sense of emotional well-being to an increased body weight

OBJECTIVES

The neurobiological mechanisms linking obesity to emotional distress remain largely undiscovered.

METHODS

In this pilot study, we combined positron emission tomography, using the norepinephrine transporter (NET) tracer [(11)C]-O-methylreboxetine, with functional connectivity magnetic resonance imaging, the Beck depression inventory (BDI), and the impact of weight on quality of life-Lite questionnaire (IWQOL-Lite), to investigate the role of norepinephrine in the severity of depression (BDI), as well as in the loss of emotional well-being with body weight (IWQOL-Lite).

RESULTS

In a small group of lean-to-morbidly obese individuals (n=20), we show that an increased body mass index (BMI) is related to a lowered NET availability within the hypothalamus, known as the brain's homeostatic control site. The hypothalamus displayed a strengthened connectivity in relation to the individual hypothalamic NET availability to the anterior insula/frontal operculum, as well as the medial orbitofrontal cortex, assumed to host the primary and secondary gustatory cortex, respectively (n=19). The resting-state activity in these two regions was correlated positively to the BMI and IWQOL-Lite scores, but not to the BDI, suggesting that the higher the resting-state activity in these regions, and hence the higher the BMI, the stronger the negative impact of the body weight on the individual's emotional well-being was.

CONCLUSIONS

This pilot study suggests that the loss in emotional well-being with weight is embedded within the central norepinephrine network.

Interaction of thyroid hormone with brown adipose tissue

Brown adipose tissue (BAT) plays an important role in regulating core-body temperature in various species including man. [18F]FDGPET/ CT imaging first revealed the presence of metabolically active BAT depots and that decreased BAT function is associated with various metabolic conditions. Thyroid hormone (TH) in concert with sympathetic nervous system signalling (SNS) stimulates BAT thermogenesis and thyroid disorders result in dysfunctional BAT. Currently, research is focussing not only on BAT regulation but also on browning of white adipose tissue (WAT) to BAT beige adipose tissue (BeAT) in order to develop novel treatments for human obesity and related conditions. While [18F]FDG-PET/ CT imaging is continuing to provide valuable insights into BAT and BeAT function in health and disease, there is a pressing need to develop alternative radiotracers that reliably track their activity in vivo. As a result it is expected that preclinical micro PET/CT investigations of BAT and BeAT will gain in prominence.

The aim of this short review is to i) describe fundamentals in BAT biology, ii) highlight some of the clinical and preclinical studies performed on humans and rodents with a focus on TH, BAT and PET/CT, and iii) bridge these data with our own studies within the DFG thyroid transact priority program.

Interaction of thyroid hormone with brown adipose tissue. Lessons learned from PET-CT

Brown adipose tissue (BAT) plays an important role in regulating core-body temperature in various species including man. [18F]FDG-PET/CT imaging first revealed the presence of metabolically active BAT depots and that decreased BAT function is associated with various metabolic conditions. Thyroid hormone (TH) in concert with sympathetic nervous system signalling (SNS) stimulates BAT thermogenesis and thyroid disorders result in dysfunctional BAT. Currently, research is focussing not only on BAT regulation but also on browning of white adipose tissue (WAT) to BAT beige adipose tissue (BeAT) in order to develop novel treatments for human obesity and related conditions. While [18F]FDG-PET/CT imaging is continuing to provide valuable insights into BAT and BeAT function in health and disease, there is a pressing need to develop alternative radiotracers that reliably track their activity in vivo. As a result it is expected that preclinical micro PET/CT investigations of BAT and BeAT will gain in prominence. The aim of this short review is to i) describe fundamentals in BAT biology, ii) highlight some of the clinical and preclinical studies performed on humans and rodents with a focus on TH, BAT and PET/CT, and iii) bridge these data with our own studies within the DFG thyroid transact priority program.

Radioligand imaging of α4β2* nicotinic acetylcholine receptors in Alzheimer's disease and Parkinson's disease

The α4β2* nicotinic acetylcholine receptors (α4β2*-nAChR) are highly abundant in the human brain. As neuromodulators they play an important role in cognitive functions such as memory, learning and attention as well as mood and motor function. Post mortem studies suggest that abnormalities of α4β2*-nAChRs are closely linked to histopathological hallmarks of Alzheimer's disease (AD), such as amyloid aggregates/oligomers and tangle pathology and of Parkinson's disease (PD) such as Lewy body pathology and the nigrostriatal dopaminergic deficit. In this review we summarize and discuss nicotinic receptor imaging findings of 2-[18F]FA-85380 PET, [11C]nicotine PET and 5-[123I]IA-85380 SPECT studies investigating α4β2*-nAChR binding in vivo and their relationship to mental dysfunction in the brain of patients with AD and patients out of the spectrum of Lewy body disorders such as PD and Lewy body dementia (DLB). Furthermore, recent developments of novel α4β2*-nAChR-specific PET radioligands, such as (-)[18F]Flubatine or [18F]AZAN are summarized. We conclude that α4β2*-nAChR-specific PET might become a biomarker for early diagnostics and drug developments in patients with AD, DLB and PD, even at early or prodromal stages.

Dual-mode hydrodynamic railing and arraying of microparticles for multi-stage signal detection in continuous flow biochemical microprocessors

Continuous flow particulate-based microfluidic processors are in critical demand for emerging applications in chemistry and biology, such as point-of-care molecular diagnostics. Challenges remain, however, for accomplishing biochemical assays in which microparticle immobilization is desired or required during intermediate stages of fluidic reaction processes. Here we present a dual-mode microfluidic reactor that functions autonomously under continuous flow conditions to: (i) execute multi-stage particulate-based fluidic mixing routines, and (ii) array select numbers of microparticles during each reaction stage (e.g., for optical detection). We employ this methodology to detect the inflammatory cytokine, interferon-gamma (IFN-γ), via a six-stage aptamer-based sandwich assay.

Evidence of end-effector based gait machines in gait rehabilitation after CNS lesion

BACKGROUND

A task-specific repetitive approach in gait rehabilitation after CNS lesion is well accepted nowadays. To ease the therapists' and patients' physical effort, the past two decades have seen the introduction of gait machines to intensify the amount of gait practice. Two principles have emerged, an exoskeleton- and an endeffector-based approach. Both systems share the harness and the body weight support. With the end-effector-based devices, the patients' feet are positioned on two foot plates, whose movements simulate stance and swing phase.

OBJECTIVE

This article provides an overview on the end-effector based machine's effectiveness regarding the restoration of gait.

METHODS

For the electromechanical gait trainer GT I, a meta analysis identified nine controlled trials (RCT) in stroke subjects (n = 568) and were analyzed to detect differences between end-effector-based locomotion + physiotherapy and physiotherapy alone.

RESULTS

Patients practising with the machine effected in a superior gait ability (210 out of 319 patients, 65.8% vs. 96 out of 249 patients, 38.6%, respectively, Z = 2.29, p = 0.020), due to a larger training intensity. Only single RCTs have been reported for other devices and etiologies.

CONCLUSION

The introduction of end-effector based gait machines has opened a new succesful chapter in gait rehabilitation after CNS lesion.

Visualizing inflammation activity in rheumatoid arthritis with Tc-99 m anti-CD4-mAb fragment scintigraphy

PURPOSE

T-cell-located CD4 antigen represents one of the therapeutic targets in rheumatoid arthritis (RA). However, up to now there is no established imaging tool to visualize this target in vivo. The aim of our study was to assess the safety and tolerability of a technetium-99m labelled murine anti-human CD4 IgG1-Fab fragment ([(99m)Tc]-anti-CD4-Fab, [(99m)Tc]-EP1645) in patients with active synovitis due to RA, and to evaluate its potential as a marker of disease activity.

METHODS

In the present phase I proof of principle study five patients with RA were examined. Planar scans of the whole body, hands, and feet were taken 30 min up to 24h after application of 550 ± 150 MBq [(99m)Tc]-anti-CD4-Fab, followed by visual analyses, comparison with clinical data in 68 joints per patient and semiquantitative analysis of hand and wrist joints.

RESULTS

Neither infusion related adverse events nor adverse events during follow up were observed. No increase in human anti-murine antibody titres was seen. All patients had positive scans in almost 70% of clinically affected joints. Positive scans were also found in 8% of joints without evidence of swelling or tenderness.

CONCLUSION

Scintigraphy with [(99m)Tc]-anti-CD4-Fab is a promising technique for evaluation of inflammatory activity in patients with RA, pre-therapeutical evaluation of CD4 status and therapy control. Tracer uptake in clinically inconspicuous joints strongly indicates diagnostic potential of [(99m)Tc]-anti-CD4-Fab. Whether this technique is eligible as a prognostic factor in RA needs to be analysed in further studies as well as the pathophysiological background of clinically affected joints lacking tracer uptake.

[Mental distress and quality of life in tinnitus patients]

BACKGROUND

Tinnitus is a disease with a high prevalence that is often combined with psychiatric comorbidity. The aim of this study was to identify the dimensions of quality of life in which tinnitus patients are especially affected, and how these affections change during a therapy, including a hyperbaric oxygen therapy.

MATERIAL AND METHODS

120 patients suffering from tinnitus were examined at 3 time points: at the beginning (t1) and the end (t2) of a 2-week hyperbaric oxygen therapy, and 4 weeks later (t3). The following questionnaires were adopted: Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, and the quality of life instrument EORTC QLQ-C30.

RESULTS

Compared with the general population, tinnitus patients were impaired in all areas of quality of life. The greatest differences were found in the scales Social, Cognitive, Emotional and Role Functioning and in the field of financial difficulties with effect sizes of about 1.5. During the therapy, the scores improved, reaching roughly the middle between the initial patients' scores and the values of the general population. The directly assessed subjective improvement due to the therapy was only marginally correlated with the differences in the questionnaires.

CONCLUSION

Since there was no control group without hyperbaric oxygen therapy, the results do not justify conclusions about the effectiveness of this therapy. However, the findings document multiple impairments of the patients (especially psycho-social disturbances) and show hints for supportive offers.

Use of the robot assisted gait therapy in rehabilitation of patients with stroke and spinal cord injury

Difficulty in walking is a major feature of neurological disease, and loss of mobility is the activity of daily living on which patients place the greatest value. The impact on patients is enormous, with negative ramifications on their participation in social, vocational, and recreational activities. In current clinical practice the gait restoration with robotic device is an integral part of rehabilitation program. Robot therapy involves the use of a robot exoskeleton device or end-effector device to help the patient retrain motor coordination by performing well-focused and carefully directed repetitive practice. The exoskeleton, as an assistive device, is also an external structural mechanism with joints and links corresponding to those of the human body. These robots use joint trajectories of the entire gait cycle and offer a uniform (more or less) stiff control along this trajectory. In this field the new powered exoskeleton ReWalk (Argo Medical Technologies Ltd) was developed to have an alternative mobility solution to the wheelchair and rehabilitation treatment for individuals with severe walking impairments, enabling them to stand, walk, ascend/descent stairs and more. The end-effector-based robot is a device with footplates placed on a double crank and rocker gear system. Alternatives to powered exoskeletons are devices that use movable footplates to which the patient's feet are attached. All devices include some form of body weight support. Prominent goals in the field include: developing implementable technologies that can be easily used by patients, therapists, and clinicians; enhancing the efficacy of clinician's therapies and increasing the ease of activities in the daily lives of patients.

An early botulinum toxin A treatment in subacute stroke patients may prevent a disabling finger flexor stiffness six months later: a randomized controlled trial

OBJECTIVE

The study asked whether an early botulinum toxin A (BTX-A) injection in subacute stroke patients may prevent a disabling finger flexor stiffness six months later.

DESIGN

Single-blind, randomized pilot study.

SETTING

Inpatient rehabilitation centre.

SUBJECTS

Eighteen stroke patients, interval 4-6 weeks, non-functional arm, Fugl-Meyer arm score (0-66) <20, beginning elevated finger flexor tone, randomly allocated to group A or B.

INTERVENTIONS

In group A patients 150 units BTX-A (Xeomin) injected into the deep and superficial finger (100 units) and wrist flexors (50 units), no injection in group B patients. Comprehensive rehabilitation in both groups.

MAIN MEASURES

Primary variable was the Modified Ashworth Scale score (0-5) of the finger flexors; secondary variables were whole arm muscle tone with REPAS (a summary rating scale for resistance to passive movement), its motor control with the Fugl-Meyer arm score, and a disability scale, blindly assessed at T0 (start), T1 (four weeks) and T6 (six months).

RESULTS

Homogeneous groups at T0. Significantly less finger flexor stiffness in the BTX-A group at T1 and T6, the mean (SD) Modified Ashworth Scale scores in group A (B) were: 1.7 ± 0.5 (1.6 ± 0.5) at T0; 0.4 ± 0.5 (1.9 ± 0.7) at T1; and 1.4 ± 0.7 (2.4 ± 0.9) at T6. Among the secondary measures, the disability score, namely the items pain and passive nail trimming, was lower in group A at T1 and T6.

CONCLUSIONS

The results indicate an effect of early BTX-A injection on finger flexor stiffness six months later, presumably attributable to a reduced contracture development. Effect size calculation suggests inclusion of at least 17 patients per group excluding drop-outs in a warranted placebo-controlled trial.