Psychometric properties of the simple test for evaluating hand function in patients with stroke.

OBJECTIVE: The simple test for evaluating hand function (STEF) is widely used for clinical evaluation of upper extremity function in Japan. However, except for test-re-test reliability, its psychometric properties have not been investigated. The aim of this study is to explore its internal consistency, concurrent validity and responsiveness in patients with sub-acute stroke. DESIGN: This was a prospective longitudinal study. PATIENTS: Thirty-four inpatients who had suffered hemiparetic stroke within 60 days of participation were enrolled. METHODS: To investigate its internal consistency and responsiveness, they were assessed with the STEF and Action Research Arm Test (ARAT) at admission and 3 weeks later. To explore its concurrent validity, the Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL) and Functional Independence Measure (FIM™) were also evaluated at admission. RESULTS: The Cronbach's alpha for the STEF was 0.98-0.99, indicating excellent internal consistency. The STEF score strongly correlated with the ARAT, FMA and MAL scores and moderately with the FIM™ score. Effect sizes and the standardized response mean were 0.27 and 0.52 for the STEF and 0.30 and 0.95 for the ARAT, respectively. CONCLUSION: This study indicates that the STEF is reliable, valid and sensitive to changes when applied to patients with sub-acute stroke.

Rational design of pH-responsive near-infrared spirocyclic cyanines: the effects of substituents and the external environment.

pH-responsive spirocyclic cyanine dyes were designed and synthesized. The equilibrium constant for cyclization (pKcycl) could be rationally controlled by changing the nucleophilic moiety and the side chains. Encapsulation in polymeric micelles inhibited the H-aggregation of the dye, and the pKcycl could be shifted according to the amphiphilic polymer employed.

[Palliative surgery for malignant bowel obstruction in patients with advanced and recurrent gastroenterological cancer].

We report the outcomes of palliative surgery for the treatment of malignant bowel obstruction in patients with advanced gastroenterological cancer. We studied 20 patients who had undergone palliative surgery over 3 years. We analyzed the clinical findings, surgical procedure, postoperative clinical course, and prognosis. The origin of the patients was colorectal cancer( 9 cases), gastric cancer( 4 cases), uterine cancer( 3 cases), pancreatic cancer( 2 cases), bladder( 1 case), and anal cancer (1 case). Small bowel obstruction was noted in 8 cases and colorectal obstruction was noted in 14 cases. Colostomy was performed in 13 cases, resection and reconstruction were performed in 6 cases, and bypass was performed in 4 cases. Ninety percent of the patients were able to eat solid food following the surgery, but 20% of the patients were forced to have bowel obstruction. The median survival time after palliative surgery was 3 (range, 0-15) months, and 6 patients (30%) died within 2 months. We concluded that palliative surgery for the treatment of malignant bowel obstruction could improve the patients' quality of life. The decision for performing palliative surgery should be made while considering the patient's prognosis, wishes, and potential for symptom improvement.

Performance comparison of peripherally inserted central venous catheters in gastrointestinal surgery: a randomized controlled trial.

BACKGROUND & AIMS: Peripherally inserted central venous catheters (PICC) are long-term vascular access devices inserted through a peripheral vein of the arm and serve as an alternative to traditional central venous catheters. Currently different types of PICCs are available. No data, however, are available in regard to materials and tip designs. We designed a prospective, randomized trial comparing two major PICCs with different material and tip design: a silicone catheter with distal side slits (Groshong Catheter) and a polyurethane catheter with open-end tip (PI Catheter). METHODS: Twenty-six patients who underwent PICCs placement between August 2010 and December 2010 were enrolled in the study. The primary endpoint was the completion rate of PICC indication. Secondary endpoints were complications rate. RESULT: The completion rate of PICC indication was not different significantly (81.8% and 92.9%, p = 0.5648) and the total complication rate were also not different significantly (9.1% and 14.3%, P = 1.0000) between two catheters. In detail, PI Catheter were associated with a significantly higher incidence of catheter occlusion, and Groshong Catheter were associated with a significantly hemorrhages after removal. CONCLUSION: There was no difference in the durability and the complication between Groshong Catheter and PI Catheter. (UMIN Clinical Trial Registry UMIN000005451).

Effectiveness of hybrid assistive neuromuscular dynamic stimulation therapy in patients with subacute stroke: a randomized controlled pilot trial.

BACKGROUND AND OBJECTIVE: Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy was devised to facilitate the use of the hemiparetic upper extremity in daily life by combining assistive neuromuscular electrical stimulation, referred to as the integrated volitional electrical stimulator (IVES), with a splint. The aim of this study is to assess the effectiveness of HANDS therapy for patients with subacute stroke. METHODS: The participants were 24 inpatients receiving rehabilitation for hemiparetic stroke within 60 days of onset. Entry criteria included inability to individuate finger extension. Patients were randomly assigned to 2 groups. The HANDS group (n = 12) used the IVES combined with a wrist splint for 8 hours a day for 3 weeks, and the control group (n = 12) wore a wrist splint alone. All patients received the same daily dose and length of standard poststroke multidisciplinary rehabilitation. Outcome measures were the upper extremity portion of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log-14 (MAL). RESULTS: In all, 10 patients in each group completed the interventions. Compared with the control group, the HANDS group showed significantly greater gains in distal (wrist/hand) portion of the FMA (P < .01) and improvement of the ARAT (P < .05). The gains in the MAL did not differ. No adverse effects occurred and the HANDS therapy was well accepted. CONCLUSION: HANDS therapy in addition to conventional therapy may improve hand function in patients with moderate to severe hand impairment during early rehabilitation.