Feasibility and efficacy of an early sensory-motor rehabilitation program on hand function in patients with stroke: a pilot, single-subject experimental design.

OBJECTIVE: Hand and upper limb functional impairments following stroke lead to limitations in performing activities of daily living. We aimed to investigate feasibility and efficacy of an early sensory-motor rehabilitation program on hand and upper limb function in patients with acute stroke. DESIGN: A pilot, single-subject experimental, A-B-A study. SETTING: Stroke unit of an educational hospital and an outpatient occupational therapy clinic. PARTICIPANTS: A convenience sample including five people with acute stroke. PROCEDURES: Participants received 3 h of an intensive hand and upper limb sensory and motor rehabilitation program, 5 days per week for 3 months (15-min mental imagery, 15-min action observation, 30-min mirror therapy, 1.5-h constraint-induced movement therapy, and 30-min bilateral arm training). Activities were chosen based on the task-oriented occupational therapy approach. OUTCOME MEASURES: An assessor blinded to intervention program measured sensory and motor functions using action research arm test, box and block test, Semmes-Weinstein monofilaments, and upper extremity section of Fugl-Meyer assessment. RESULTS: Assessment data points in intervention and follow-up phases compared to baseline were in higher levels, sloped upwardly, and increased significantly for all participants in all outcome measures. CONCLUSIONS: The present pilot study showed that a package of nowadays evidence-based rehabilitation methods including mental imagery, action observation, mirror therapy, modified constraint-induced movement therapy, bilateral arm training, and task-oriented occupational therapy approach is able to improve sensory and motor functions of the hand and upper limb in patients with acute stroke.

Susceptibility and Severity of COVID-19 Are Both Associated With Lower Overall Viral-Peptide Binding Repertoire of HLA Class I Molecules, Especially in Younger People.

An important number of studies have been conducted on the potential association between human leukocyte antigen (HLA) genes and COVID-19 susceptibility and severity since the beginning of the pandemic. However, case-control and peptide-binding prediction methods tended to provide inconsistent conclusions on risk and protective HLA alleles, whereas some researchers suggested the importance of considering the overall capacity of an individual's HLA Class I molecules to present SARS-CoV-2-derived peptides. To close the gap between these approaches, we explored the distributions of HLA-A, -B, -C, and -DRB1 1st-field alleles in 142 Iranian patients with COVID-19 and 143 ethnically matched healthy controls, and applied in silico predictions of bound viral peptides for each individual's HLA molecules. Frequency comparison revealed the possible predisposing roles of HLA-A*03, B*35, and DRB1*16 alleles and the protective effect of HLA-A*32, B*58, B*55, and DRB1*14 alleles in the viral infection. None of these results remained significant after multiple testing corrections, except HLA-A*03, and no allele was associated with severity, either. Compared to peptide repertoires of individual HLA molecules that are more likely population-specific, the overall coverage of virus-derived peptides by one's HLA Class I molecules seemed to be a more prominent factor associated with both COVID-19 susceptibility and severity, which was independent of affinity index and threshold chosen, especially for people under 60 years old. Our results highlight the effect of the binding capacity of different HLA Class I molecules as a whole, and the more essential role of HLA-A compared to HLA-B and -C genes in immune responses against SARS-CoV-2 infection.

Association between iron deposition in splenic,hepatic and myocardial tissues assessed by T2* relaxometry technique.

BACKGROUND: Decreasing signal intensity of the spleen assessed by T2* MRI is a frequent finding in patients with beta-thalassemia due to iron deposition within the reticuloendothelial cells in this organ. This parameter can also be applied to determine the candidates for blood cell transfusion. However, the association between splenic siderosis and iron overload in other vital organs such as heart and liver remains unclear. The present study aimed to assess the correlation between iron deposition in splenic, hepatic and myocardial tissues by T2* relaxometry technique. METHODS: This cross-sectional study included 39 consecutive patients with a definitive diagnosis of beta-thalassemia major who underwent spleen, liver and heart MRI examinations for iron deposition and cardiac function. RESULTS: No significant correlation was found between the heart and splenic T2* relaxation time (R=0.206, P=0.357). We revealed a strong correlation between the splenic T2* relaxation time and hepatic calculated T2*s (R=0.515, P=0.014). The liver T2* values can be predicted from the splenic T2*s by a new linear equation. According to the ROC curve analysis, the splenic T2* could significantly, but moderately predict moderate to severe from mild liver iron excess (AUC=0.667). CONCLUSION: Our study demonstrated a significant linear correlation between the splenic and hepatic T2* relaxation time, probably indicative of the same iron deposition mechanism, and made us available to write a linear model that would predict the deposited iron density in the spleen with the use of the magnetic resonance T2* values.

A retrospective cohort of coronary artery disease development after at least two angiograms in patients with normal coronary angiograms or mild coronary artery disease.

BACKGROUND: Coronary Artery Disease is one of the leading causes of death in the world. CAD usually progresses slowly during time and patients with normal or near-normal coronary arteries are also at risk of developing CAD. It is now believed that even mild atherosclerosis can increase the rate of CAD. METHODS: This is a retrospective, descriptive and analytic study. We selected patients who had undergone at least two diagnostic coronary angiographies at Tehran Heart Center and had normal coronary structure or mild CAD in initial angiography. The data was obtained from the Tehran Heart Center Angiography Databank. Predicting factors in the development of CAD were determined. RESULTS: Data on 556 patients were reviewed. The median interval between the initial and final coronary catheterization was 37.6 months. On the final evaluation, 216 patients (38.8%) found to have developed some degrees of coronary artery disease. Based on the multivariate analysis, age, hematocrit, cigarette smoking, hypertension, and initial presentation with stable and unstable angina were found to be independent predictors of progression to CAD in patients. CONCLUSION: In the end, 40% of patients who had normal coronary arteries or minimal CAD in the initial angiography report, developed some degrees of CAD and some clinical indices can predict the risk of CAD.

Phytotoxic Potential and Phenolic Profile of Extracts from Scrophularia striata.

A large number of plants produce secondary metabolites known as allelochemicals that are capable of inhibiting the germination of competitive species. This process is known as allelopathy and is mediated by several classes of chemicals, among which phenolic compounds are the most frequent. Thus, plant allelochemicals can be used to control weeds in agricultural systems. In the present work, we analyzed the phenolic profile and phytotoxic potential of different extracts (pure water or water: ethanol 50:50) from Scrophularia striata plants that were collected from two ecological regions in Iran (Pahleh and Lizan). The total polyphenolic content (TPC), as evaluated by the Folin-Ciocolteau method, ranged from 28.3 mg/g in the aqueous extract obtained from the Lizan ecotype to 39.6 mg/g in the hydroalcoholic extract obtained from the Pahleh ecotype. Moreover, HPLC analysis was aimed at determining the content of eight phenolic compounds, namely eugenol, rosmarinic acid, hesperetin, hesperedin, trans-ferulic acid, vanillin, and caffeic acid. According to the results, rosmarinic acid appeared to be the most abundant component. The phytotoxic activities of S. striata extracts were examined on the seed germination of a crop species, Lepidium sativum, and two weeds, Chenopodium album and Malva sylvestris. All extracts showed inhibitory effects on these species. The efficiency of these inhibitory effects depended on the type of plant species, origin, and concentration of extract. The highest phytotoxic activity was caused by approximately 1% concentration of extract. The most susceptible weed was M. sylvestris. The extracts that were obtained from the Pahleh ecotype, notably the hydroalcoholic ones, showed higher phytotoxicity against L. sativum, C. album and M. sylvestris. These results encourage further studies to support the use of S. striata as a source of bioherbicides.

Challenging case of muscle bridge; a 15-year follow-up of a patient.

BACKGROUND: Anatomically myocardial bridging (MB) consists of either superficial myocardial fibers that traverse over the LAD or deep fibers that encircle the coronary artery. In this study, we present a patient with myocardial bridging, who was primarily diagnosed with coronary artery disease which did not properly respond to full-dose medical treatment but benefited from coronary artery bypass graft (CABG). CASE PRESENTATION: In 2017, a 53-year old man was referred to Tehran Heart Center (THC) with complaint of typical chest pain (TCP). In 2003 he had TCP and underwent coronary angiogram (CAG), due to positive non-invasive tests. Muscle-bridge in LAD was diagnosed. In 2007, he was symptomatic and another CAG was done, and percutaneous coronary intervention (PCI) with stenting was performed. In 2008 he became symptomatic and his interventionist, decided to perform another CAG. At that time, he had CABG. He was asymptomatic until 2015, he referred to us with the same TCP and we decided to perform CAG for the fourth time. After two years, again another PCI was done due to in-stent restenosis. CONCLUSION: Revascularization should be considered in MB refractory to medical treatment. However, coronary perforation, in-stent restenosis and graft failure are major concerns.

Measuring the reliability of sagittal facial anthropometric measurements under soft tissue displacement using a modified ruler.

OBJECTIVE: Despite the current use of radiography for quantifying sagittal skeletal measurements, it is an unsuitable way for screening or epidemiologic purposes. Although not fully approved, anthropometric measurements have been suggested as a substitute, and considering displacement of soft tissues, could possibly lead to more consistent results. The purpose of this study was to evaluate the reliability of anthropometric anteroposterior facial measurements under soft tissue compression using a special ruler. MATERIAL AND METHODS: Anthropometric measurements were done with a specifically designed sliding ruler twice on 36 adult patients with a 14 day lag between two measurements. The ruler measured the distance between the external acoustic meatus and the nasion (Na), subnasal (Sn) point and the soft tissue pogonion (Pog). The soft tissue was displaced during measurements only to the extent that the underlying hard tissue resistance was felt subjectively by each assessor. The intraclass correlation coefficient (ICC) was calculated for both inter- and intra- rater measurements using SPSS software. RESULTS: All measurements had inter- and intrarater agreements above 0.9, with only a few parameters having lower bound confidence intervals below 0.9, but more than 0.8. CONCLUSION: Sagittal facial anthropometric measurements under soft tissue displacement using the specific ruler are valid and reliable and could possibly aid orthodontists in chairside craniofacial assessments.