[Does upper limb robot-assisted rehabilitation contribute to improve the prognosis of post-stroke hemiparesis?]. / La rééducation du membre supérieur assistée par robot contribue-t-elle à améliorer le pronostic de l'hémiparésie vasculaire ?

INTRODUCTION: Upper limb robot-assisted rehabilitation is a novel physical treatment for neurological motor impairments. During the last decade, this rehabilitation option utilizing technological tools has been evaluated in hemiparetic patients, mostly after stroke. STATE OF ART: Studies at acute and chronic stages suggested good tolerance and a significant and persistent reduction of motor impairment; a real impact on disability has been shown in acute/sub acute patients. PERSPECTIVES: Improved access to rehabilitation robots and an optimal use will probably be associated with higher efficiency of rehabilitative work in the paretic upper limb. CONCLUSIONS: Even if this treatment is still confined to a narrow circle of users, the device's biomechanical properties and clinical suggestions from the literature may show promise for the future of rehabilitation.

[Contributions of robotic devices to upper limb poststroke rehabilitation]. / Apports des dispositifs robotisés à la rééducation du membre supérieur hémiplégique.

INTRODUCTION: Poststroke rehabilitation care has evolved considerably over the last decade. The emergence of the concepts of brain plasticity and motor learning has led to the development of new therapeutic approaches. Most of the new strategies are based on movement therapy, which can have a real impact on neurological recovery, sometimes with significant functional benefit for the patient. STATE OF THE ART: In this context of evolving practices, the hemiplegic arm is the subject of special attention. Considering the often unfavorable "natural" prognosis and the relatively limited impact of conventional therapies; researchers have focused work on new alternatives. Cooperation between developers of technological advances and the medical community has led to the development of innovative therapeutic options often based on the use of specific technological tools (functional electric stimulation, virtual reality, transcranial magnetic stimulation...) to solicit or facilitate movement. PERSPECTIVES/CONCLUSION: Robot-assisted rehabilitation lies within this scope. The positive results reported in the most recent publications and the growing interest for this type of therapy in the fields of medical and engineering research should open the way for extremely promising prospects. The technological performance of new robots has nevertheless raised a large number of unanswered questions, implying a significant amount of further research.

Efficacy of a green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy expenditure and fat oxidation in humans.

BACKGROUND: Current interest in the role of functional foods in weight control has focused on plant ingredients capable of interfering with the sympathoadrenal system. OBJECTIVE: We investigated whether a green tea extract, by virtue of its high content of caffeine and catechin polyphenols, could increase 24-h energy expenditure (EE) and fat oxidation in humans. DESIGN: Twenty-four-hour EE, the respiratory quotient (RQ), and the urinary excretion of nitrogen and catecholamines were measured in a respiratory chamber in 10 healthy men. On 3 separate occasions, subjects were randomly assigned among 3 treatments: green tea extract (50 mg caffeine and 90 mg epigallocatechin gallate), caffeine (50 mg), and placebo, which they ingested at breakfast, lunch, and dinner. RESULTS: Relative to placebo, treatment with the green tea extract resulted in a significant increase in 24-h EE (4%; P < 0.01) and a significant decrease in 24-h RQ (from 0.88 to 0.85; P < 0.001) without any change in urinary nitrogen. Twenty-four-hour urinary norepinephrine excretion was higher during treatment with the green tea extract than with the placebo (40%, P < 0.05). Treatment with caffeine in amounts equivalent to those found in the green tea extract had no effect on EE and RQ nor on urinary nitrogen or catecholamines. CONCLUSIONS: Green tea has thermogenic properties and promotes fat oxidation beyond that explained by its caffeine content per se. The green tea extract may play a role in the control of body composition via sympathetic activation of thermogenesis, fat oxidation, or both.

Comparison of calcaneal ultrasound and DXA in young women.

PURPOSE: The purpose of the study was to assess quantitative ultrasound (QUS) parameters in collegiate female gymnasts, a population whose training incorporates high-impact loading, which is particularly osteogenic, and to determine the discriminative capacity of this relatively new radiation-free technique compared with bone densitometry in a young healthy population. METHODS: We studied 19 collegiate gymnasts and 23 healthy controls undergoing regular weight-bearing activity, matched for age (gymnasts 19.2 +/- 1.2, controls 19.9 +/- 1.6 yr) and body weight (gymnasts 56.7 +/- 3.7, controls 57.7 +/- 7.8 kg). QUS parameters of the calcaneus (broadband ultrasound attenuation (BUA), bone velocity (BV), and speed of sound (SOS)) were measured by a Walker Sonix UBA 575+. Bone mineral density (BMD; g x cm(-2)) of the lumbar spine, hip (femoral neck, trochanter, Ward's triangle) and whole body was assessed by dual energy x-ray absorptiometry (DXA, Hologic QDR 1000/W). Data analysis included unpaired two-tailed Student's t-tests, analysis of variance, Pearson product-moment, and Spearman rank-order correlations. RESULTS: Regional and whole body BMD of gymnasts was greater than controls (P < 0.001), with the difference being 7-28%. Average QUS parameters of the right and left calcaneus were also higher (P < 0.001) in the gymnasts. BUA, BV, and SOS were significantly (P < 0.001) correlated to each bone site with r = 0.54-0.79. Analysis of receiver operating characteristic (ROC) curves indicated no significant difference in sensitivity and specificity for QUS and DXA measures. CONCLUSIONS: These results indicate that QUS parameters of the calcaneus are higher in young women gymnasts compared to individuals who undergo regular weight-bearing activity and that QUS parameters are able to discriminate between these two groups in a similar manner as does regional and whole body BMD.

Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults.

OBJECTIVE: To determine the effect of frequency of resistive training on gain in muscle strength and neuromuscular performance in healthy older adults. DESIGN: A randomized controlled trial with subjects assigned either to high-intensity resistance training 1 (EX1), 2 (EX2), or 3 (EX3) days per week for 24 weeks or to a control group (CO). SETTING: An exercise facility at an academic medical center. SUBJECTS: Forty-six community-dwelling healthy men (n = 29) and women (n = 17) aged 65 to 79 years. INTERVENTION: Progressive resistance training consisting of three sets of eight exercises targeting major muscle groups of the upper and lower body, at 80% of one-repetition maximum (1-RM) for eight repetitions, either 1, 2, or 3 days per week. MEASURES: Dynamic muscle strength (1-RM) using isotonic equipment every 4 weeks, bone mineral density and body composition by dual energy X-ray absorptiometry (DXA), and neuromuscular performance by timed chair rise and 6-meter backward tandem walk. RESULTS: For each of the eight exercises, muscle strength increased in the exercise groups relative to CO (P < .01), with no difference among EX1, EX2 and EX3 groups at any measurement interval. Percent change averaged 3.9 +/- 2.4 (CO), 37.0 +/- 15.2 (EX1), 41.9 +/- 18.2 (EX2), and 39.7 +/- 9.8 (EX3). The time to rise successfully from the chair 5 times decreased significantly (P < .01) at 24 weeks, whereas improvement in the 6-meter backward tandem walk approached significance (P = .10) in the three exercise groups compared with CO. Changes in chair rise ability were correlated to percent changes in quadriceps strength (r = -0.40, P < .01) and lean mass (r = -0.40, P < .01). CONCLUSIONS: A program of once or twice weekly resistance exercise achieves muscle strength gains similar to 3 days per week training in older adults and is associated with improved neuromuscular performance. Such improvement could potentially reduce the risk of falls and fracture in older adults.

Agreement between 'time-blind' and 'time-non-blind' assessments of depressive symptomatology.

In a 4-week study, two methods were used simultaneously in the assessment of depressive symptomatology with videotaped structured clinical interviews: a 'time-non-blind' (TNB) method (chronological order, observer aware of the previous duration of drug treatment) and a 'time-blind' (TB) method (no chronological order, rater unaware of the previous duration of treatment). Sixty newly admitted depressed inpatients with Montgomery-Asberg Depression Rating Scale scores higher than 20 were assessed before (D0), after 10 days (D10) and after 28 days (D28) of antidepressant treatment. Agreement between TNB and TB methods on the Montgomery-Asberg Depression Rating Scale, measured by intra-class correlation coefficients, was good at D0 (0.68), excellent at D10 (0.81) and D28 (0.86), but not significantly different between D0, D10 and D28. The statistical method of Bland and Altman (1986) was also used to evaluate the degree of agreement. Results of this second analysis were in accordance with the intra-class correlation coefficient results, and showed significantly (P < 0.05) higher D0-D28 and D10-D28 intrasubject changes with the TB method, which were largely accounted for by some particular items (inner tension, pessimism, lassitude). With the Clinical Global Impression-Severity score, the Bland and Altman method failed to show significant differences between the two methods, and compared with the Montgomery-Asberg Depression Rating Scale, intra-class correlation coefficients were lower with larger confidence intervals, suggesting that global ratings are less reliable than itemized symptom ratings.

Concordance between self-report and clinician's assessment of depression.

In order to assess differences between self-assessment and clinician's assessment of depression, 64 depressed in-patients were assessed for depressive symptomatology at admission (D0), 10 days (D10) and 28 days (D28) after the beginning of antidepressant treatment, using the Inventory for Depressive Symptomatology Clinician Rated (IDS-C) and the Inventory for Depressive Symptomatology Self-Rated (IDS-SR). Associated symptoms (SCL-90R) were assessed at D0 and personality dimensions (TCI) at D28. Although agreement was high between IDS-C and IDS-SR total scores, D0, D0-D10 and D0-D28 total scores were significantly different between IDS-C and IDS-SR, showing a higher sensitivity to change for IDS-C as compared to IDS-SR. Differences between IDS-C and IDS-SR were due mostly to mood items and not to somatic items. Discrepancies between self-assessment and clinician's assessment of depressive symptomatology were linked neither to age, sex, familial status, single/recurrent and length of episode, nor to depression severity, but to associated symptoms and, to a lesser extent, personality dimensions: patients over-estimating their depressive symptomatology change relative to the psychiatrist tended to score high on phobic anxiety, Cooperativeness (especially Social Acceptance) and Self-Transcendence (especially Self-forgetfulness) and vice-versa.

Lack of association of anabolic hormone status and muscle strength with regional and whole body bone mineral density in healthy men aged 60-79 years.

This study investigated the capacity of muscle strength and anabolic hormone status to predict regional and whole body bone mineral density (BMD) in older men. Fifty-two healthy men aged 60-79 years served as subjects. BMD of the lumbar spine, proximal femur, upper and lower limbs, and whole body was assessed by dual X-ray absorptiometry. Dynamic muscle strength for several upper and lower body muscle groups was determined by the one-repetition maximum and isometric grip strength by dynamometry. Anabolic hormone status was assessed by the ratio of testosterone (T) to sex hormone binding globulin (SHBG), given as the free androgen index (FAI), and the ratio of insulin-like growth factor I (IGF-I) to IGF binding protein-3 (IGFBP-3). Age was associated with declines in dynamic strength and the log FAI. In stepwise regression analysis, only body mass was an independent predictor of whole body and upper limb BMD (R2 = 0.13), and hip adductor strength predicted the Ward's triangle (R2 = 0.14). For lumbar spine BMD, triceps extensor strength was significantly correlated (r = 0.36, p < 0.01), while no strength or hormonal variable was associated with the femoral neck, trochanter, or lower limb. The lack of association between muscle strength and BMD was generally unaltered after controlling for hormone status and body mass. There was no difference in BMD when analyzed by tertiles of log FAI or IGF-I/IGFBP-3 or by tertiles of muscle strength. These results suggest that in healthy community-dwelling men in the seventh and eighth decade, muscle strength and hormonal status are not significant contributors to regional or whole body BMD.

IDS-C and IDS-sr: psychometric properties in depressed in-patients.

Sixty-eight depressed in-patients were assessed at admission (DO), and after 5 days (D5), ten days (D10) and 28 days (D28) of antidepressant treatment, with the Inventory for Depressive Symptomatology-Clinician (IDS-C) and the Inventory for Depressive Symptomatology-Self-Rated (IDS-SR) (Rush et al., 1986), the Montgomery and Asberg Depression Rating Scale (MADRS) (Montgomery and Asberg, 1979) and the depression factor of the Symptom Check List (SCL-90R) (Derogatis, 1977), in order to assess IDS-C and IDS-SR psychometric properties in depressed in-patients and to compare IDS-C to MADRS and IDS-SR to the SCL-90R depression factor. Most of the IDS-C and IDS-SR items were significantly correlated to the final score and the Cronbach alpha coefficients were high (0.75 for the IDS-C and 0.79 for the IDS-SR). Principal Component Analyses (PCA) showed three factors for both IDS-C and IDS-SR: 'depression', 'anxiety/arousal' and 'sleep/appetite'. These results suggest satisfactory internal consistency of IDS-C and IDS-SR. Concurrent validity of the IDS-C with the MADRS was high (r = 0.81), as well as concurrent validity of the IDS-SR with the SCL-90R depression factor (r = 0.84). Concerning sensitivity to change, the four scales were able to discriminate between different levels of severity of depression. Moreover, considering paired t-tests on score changes, IDS-C sensitivity to change may be higher than MADRS sensitivity to change, this phenomenon being related to the number of items and degrees but not to the item contents. Contrary to IDS-C and MADRS, IDS-SR and SCL-90R depression factor were not different in terms of sensitivity to change. Finally, psychometric properties of IDS-C and IDS-SR in depressed in-patients are satisfactory and close to those obtained in depressed out-patients. The high sensitivity to change of the IDS-C may be an advantage for this scale as compared to the MADRS, especially in antidepressant drug trials.

Stability of recombinant vaccinia-rabies vaccine in veterinary use.

Wildlife vaccination depends on vaccines which can be orally administered by a baiting system. Therefore only two possibilities exist: either the use of attenuated strains of viruses, or recombinant vector viruses. As far as rabies is concerned, the choice of the recombinant vaccinia-rabies virus was made because it was safer and more stable. An in vitro stability study of the recombinant product compared to wild rabies virus at different temperatures (4 degrees C, 20 degrees C, 37 degrees C, 45 degrees C) showed that the recombinant virus was more stable. The stability of the recombinant virus was also tested under field conditions; besides natural freezing and thawing cycles, the virus titre remained unchanged in the bait for a month. Taking into account the fact that all baits are eaten by wild animals within this period, one can assume that the vaccine is efficacious for all baiting animals in field conditions. The stability of the recombinant vaccinia-rabies vaccine is of considerable interest in such uncontrolled conditions.

Applications of canarypox (ALVAC) vectors in human and veterinary vaccination.

This paper presents data derived from safety and efficacy studies of ALVAC-based rabies and feline leukemia virus (FeLV) vaccine candidates in target species. Inoculation of the ALVAC-RG recombinant was well tolerated in all species including humans and very young dogs. Protection induced in dogs against rabies challenge was long-lasting and could be elicited in the face of high levels of maternally-derived neutralizing antibody. Parenteral inoculation of cats with an ALVAC-FeLV recombinant was safe and induced protection against persistent infection following oro-nasal FeLV challenge.

Protection of mice and swine from pseudorabies virus conferred by vaccinia virus-based recombinants.

Glycoproteins gp50, gII, and gIII of pseudorabies virus (PRV) were expressed either individually or in combination by vaccinia virus recombinants. In vitro analysis by immunoprecipitation and immunofluorescence demonstrated the expression of a gII protein of approximately 120 kDa that was proteolytically processed to the gIIb (67- to 74-kDa) and gIIc (58-kDa) mature protein species similar to those observed in PRV-infected cells. Additionally, the proper expression of the 90-kDa gIII and 50-kDa gp50 was observed. All three of these PRV-derived glycoproteins were detectable on the surface of vaccinia virus-PRV recombinant-infected cells. In vivo, mice were protected against a virulent PRV challenge after immunization with the PRV glycoprotein-expressing vaccinia virus recombinants. The coexpression of gII and gIII by a single vaccinia virus recombinant resulted in a significantly reduced vaccination dose required to protect mice against PRV challenge. Inoculation of piglets with the various vaccinia virus-PRV glycoprotein recombinants also resulted in protection against virulent PRV challenge as measured by weight gain. The simultaneous expression of gII and gp50 in swine resulted in a significantly enhanced level of protection as evaluated by weight evolution following challenge with live PRV.

[Diagnosis of enzootic bovine leukosis by the ELISA test of mixed and individual milk]. / Dépistage de la leucose bovine enzootique à l'aide du test ELISA appliqué au lait de mélange et au lait individuel.

The ELISA test was applied to mixed milk from 325 cowsherds of the Landes region of France. From the 88 cowsheds giving a positive or inconclusive response, individual samples of milk were studied by the ELISA test, and individual samples of serum by the agar immunodiffusion test (1734 cows). The same procedure was carried out on 1250 animals in a sample of 49 cowsheds chosen at random from amongst the 237 cowsheds whose mixed milk gave a negative response to the ELISA test. The results confirmed the importance of the ELISA test applied to mixed milks, provided that the samples are studied several times per year, so as to minimize default errors. The study of individual milk allowed the identification of 92 to 94% of the infected animals, with a specificity of 98 to 99%. The systematic and repeated testing of mixed milks by the ELISA test should allow initial detection of infection and supervision of a satisfactory cost-efficiency report in the decontaminated cowsheds.

Freeze-dried vaccine against Rinderpest: stability and activity study.

A freeze-dried vaccine against Rinderpest was prepared from modified virus multiplied in calf kidney cell culture. Characteristics of the vaccine are as follows: high titre after freeze-drying (10(4) CCID50/dose), well-adapted freeze-drying stabilizer which ensures maintenance of the infective titre of the vaccinal virus, even under severe conditions (3.5 days at +45 degrees C), use of an appropriate solvent: magnesium sulphate molar solution or more simply physiological saline (for stability after reconstitution even at high temperatures--up to 4 h at +45 degrees C). The activity of the vaccine, tested in cattle by antibody titration and resistance to specific challenge perfectly satisfies requirements set by the WHO and OIE.