Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation.

BACKGROUND: Lower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke. PATIENTS AND METHODS: In a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment. RESULTS: One hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R2: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02). CONCLUSIONS: Higher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.KEY MESSAGEHigher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.Higher SES is associated with significantly higher utilization of outpatient therapies.Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery. Article registration: clinicaltrials.gov NCT04119479.

No simple brake--the complex functions of inhibitory synapses.

Synaptic inhibition can be viewed as a counterbalance of synaptic excitation. However, multiple recent studies at the cellular and network level show that inhibition serves a variety of additional, highly specific functions in the mammalian nervous system. At the molecular and cellular level, inhibitory synapses express diverse postsynaptic reversal potentials, kinetics, plasticity, and pharmacological modulation. This heterogeneity corresponds to the complexity of inhibition at the network level, where interneurons are now perceived as diverse and highly specific organizers of coherent activity patterns. We review some important new developments in the molecular, cellular and network physiology of inhibition. It turns out that understanding inhibition is a key to understanding neuronal network behaviour and, ultimately, may provide important clues for the development of novel therapeutic strategies in neuro-psychiatric diseases.

A perfluorochemical oxygen carrier (fluosol-43) in a synthetic medium used for perfusion of isolated rat liver.

An emulsion of perfluorotributylamine (Fluosol-43) was used as substitute for the gas-carrying function of erythrocytes in a synthetic medium for perfusion of isolated rat liver. The efficiency and effect of this synthetic gas-carrier were evaluated from measurements of the concentrations of rat albumin, the unsaturated vitamin B12-binding capacity of small-molecular-size vitamin B12-binding proteins (UBBC of SBP), urea nitrogen, glucose, sodium, potassium, alanine amino transferase (ALAT) in the medium, and the incorporation of 14C-lysine into the circulating proteins. Secretion of bile, portal pressure, PO2, PCO2 and pH in the affluent and the effluent mediums were also measured. The results demonstrate that the oxygen-carrying capacity of the medium and the metabolic functions of the liver were higher, and the liver damage less, when the medium included Fluosol-43 than without it. The albumin synthesis and the secretion of bile were as high as has been reported for perfusions with erythrocytes. This indicates that the oxygen carried by the Fluosol-43 was utilised by the liver, and that the metabolic functions were not adversely affected during 4 h of perfusion by the medium containing Fluosol-43.

Specific and unspecific removal of circulating noradrenaline in pulmonary and systemic vascular beds in man.

In order to study the extent and degree of specificity of the removal of circulating noradrenaline (NA) from the blood stream, during a single passage through the vascular beds of the lungs and of the forearm musculature of unanaesthetized, healthy young men, the following radiometric method was used: A misture of 3H-NA with 14C-inulin and 125I-labelled human serum albumin was injected proximally to the bed under study; six serial blood smaples were drawn distally to it, with about 15 s interval, and the disappearance of 3H-NA relatively to that of 14C-inulin and 125I-albumin was determined. 3H-NA was found to be removed from the blood stream in both these vascular beds. However, in the forearm the removal of 3H-NA was much greater, and apparently to a large extent due to specific trapping in the tissues, since the clearance of 3H-NA over the vascular bed of the forearm markedly exceeded that of 14C-inulin. During passage through the lungs removal of 3H-NA was less marked, and apparently largely unspecific, since it was initially essentially equal to that of 14C-inulin. This suggests that removal of circulating ergones of small molecular size, from the blood stream passing through the lungs, may occur initially by unspecific filtration/diffusion. Their subsequent fate would depend on whether the extraluminal tissues, supplied by the lung circulation, possess specific mechanisms for concentrating and/or inactivating each particular compound.

Studies on isolated rat liver perfused by perfluoro-compound emulsion.

Isolated rat livers were perfused for 6 hours by different types of cell-free synthetic media. Some of the media included perfluoro-compounds as an oxygen carrier. The value of the perfusion medium as blood substitute was judged on the basis of observations and measurements of a number of parameters. These were: secretion of bile, fluid pressure in the portal vein, the level of GPT (ALAT) transaminase, urea nitrogen, and glucose in the perfusate. The rate of albumin synthesis and the rate of 14-C-lysine incorporated into circulating proteins were also measured. It was found that perfusion of the isolated rat liver with the TC-199 Difco medium containing the perfluoro-compound FC-80 emulsion maintained the liver in a good condition demonstrated, among other things, by the synthesis of albumin and other proteins. The liver could be kept in a good functional condition during 6 hours perfusion with this cell-free medium. With all the other types of perfusate tested the liver did not synthesize proteins. The isolated rat liver seems to be both convenient and advantageous for testing the perfusion media with respect to their capacity to maintain important metabolic functions.