Microliter viscometry using a bright-field microscope: η-DDM.

The rheological properties of a medium can be inferred from the Brownian motion of colloidal tracer particles using the microrheology procedure. The tracer motion can be characterized by the mean-squared displacement (MSD). It can be calculated from the intermediate scattering function determined by Differential Dynamic Microscopy (DDM). Here we show that DDM together with the empirical Cox-Merz rule is particularly suited to measure the steady-shear viscosity, i.e. the viscosity towards zero frequency, due to its ability to provide reliable information on long time and length scales and hence small frequencies. This method, η-DDM, is tested and illustrated using three different systems: Newtonian fluids (glycerol-water mixtures), colloidal suspensions (protein samples) and a viscoelastic polymer solution (aqueous poly(ethylene oxide) solution). These tests show that common lab equipment, namely a bright-field optical microscope, can be used as a convenient and reliable microliter viscometer. Because η-DDM requires much smaller sample volumes than classical rheometry, only a few microliters, it is particularly useful for biological and soft matter systems.

Osteoporosis in adults with cerebral palsy: feasibility of DXA screening and risk factors for low bone density.

UNLABELLED: This study aims to describe osteoporosis screening in adults with cerebral palsy (CP) and identify any associated factors. Bone mineral density (BMD) was often lower than expected-for-age in these adults, and present even in young adulthood, particularly at the spine. Low BMD is frequent in adults with CP. INTRODUCTION: This study aims to describe the feasibility of dual-energy X-Ray absorptiometry (DXA) screening in adults with cerebral palsy (CP) and identify factors associated with low bone mineral density (BMD), including longitudinal changes. METHODS: A retrospective chart review study of these adults seen at an urban academic rehabilitation clinic and who underwent DXA scan(s). BMD and Z-scores for the lumbar spine, hips, and femoral (neck and total) were recorded. The change in BMD and Z-scores from baseline to follow-up DEXA, Gross Motor Functional Classification System (GMFCS), CP pattern (hemiplegic, diplegic, or quadriplegic), body mass index (BMI), and transfer and ambulation status were assessed. RESULTS: Forty-two patients (83 % less than age 50 years) had at least one DXA. Seventeen had at least two studies, 15 without pharmacologic interventions between studies. Thirteen fractures in eight subjects were noted, most often lower limb. Fifty percent of spine studies in individuals under 50 had a Z-score of less than -2, while 25 and 30.8 % of these individuals had such scores at the right and left total hip sites, respectively. Need for transfer assistance was associated with lower BMD and Z-scores at all hip sites, but not the lumbar spine. Progressive abnormalities were seen at follow-up DXAs at some sites, however these were not statistically significant. CONCLUSIONS: Lower than expected-for-age BMD was very frequent in adults with CP with mobility limitations, present at both spine and hip sites. Low BMI and need for transfer assistance had a negative impact on BMD. Although not statistically significant, progression of abnormalities was seen at follow-up for DXAs Z-scores at some sites, which suggests longitudinal studies in this population are needed.

Future of bariatric surgery beyond simple weight loss: Metabolic surgery.

Anatomical modifications implemented during bariatric surgery not only result in weight loss, but also lead to metabolic corrections that translate into better glycemia stability and improvement in cardiovascular and liver disorders. The logical extension of surgical indications beyond mere reduction of the body mass index (BMI) (i.e. patients with<35kg/m2) is a hot topic today in France and worldwide. Metabolic surgeries make use of multiple modalities (endoscopic, mini-invasive, invasive) that should be carried out by trained physicians and within the same type of multidisciplinary formation as that for bariatric surgery. The aim of this update is to describe the physiological mechanisms that result in the benefits of bariatric surgery, the various procedures currently available and the perspectives for this new field in visceral and digestive surgery.

Combined stoma reversal and liver resection for rectal metastatic cancer: A single center retrospective analysis.

GOAL OF THE STUDY: Concomitant liver metastases are discovered at the time of diagnosis in 25% of patients with colorectal cancers. The appropriate time to restore digestive continuity after stoma creation during rectal surgery has not yet been established. The objective of this study is to assess the morbidity of stoma reversal during the secondary hepatectomy procedure. PATIENTS AND METHODS: This was a single-center retrospective case-control study including patients who underwent ileostomy or colostomy reversal by a direct approach (REVERSAL group) compared to those who did not undergo stoma reversal (NON-REVERSAL group) during hepatic resection of rectal cancer metastasis between 2004 and 2016. Peri-operative data were collected. The primary outcome measure was the comprehensive complication index (CCI). The secondary outcomes were overall mortality, liver-related morbidity, duration of hospital stay and occurrence of gastrointestinal leaks. Statistical analysis was carried out using SPSS 23.0 software. RESULTS: Thirty liver resections were included; 14 in the REVERSAL group (female/male=11/19, age=60 years). No statistically significant difference was observed in the CCI scores (15 vs. 20.8; P=0.6). Complications occurred in 9 (64%) and 8 (50%) patients in the REVERSAL and NON-REVERSAL groups, respectively (P=0.48). No gastro-intestinal leaks or post-operative mortality occurred. CONCLUSION: Stoma reversal during hepatectomy for liver metastasis from a primary rectal cancer represents a safe alternative since post-operative outcome was not associated with additional morbidity in this series.

Physical rehabilitation of the cancer patient.

Significant numbers of cancer patients have physical limitations as a result of their cancer or its treatment. Most commonly, this impairment results from prolonged bed rest and deconditioning syndrome or neurologic loss frequently coupled with deconditioning. What few studies have been done show that functional improvement through rehabilitation does occur. For many cancer patients, rehabilitation is an appropriate option, viewed favorably by patients and their families. However, as opposed to other causes of impairment, the benefits and goals of rehabilitation must be carefully weighed in concert with the goals of the cancer patient, all in an effort to add to his or her quality of life.

[A contribution of the histochemical behaviour of the unspecific esterases in hypothalamus, neurohypophysis, adrenal and parotid gland of the rat against inhibitors]. / Ein Beitrag zum histochemischen Verhalten der unspezifischen Esterasen in Hypothalamus, Neuropophyse, Nebenniere und Parotis der Ratte gegenüber Inhibitoren

On continuation of study by KURZ and GOSLAR (1974) concerning the inhibitory effects to non specific esterases on liver and kidney, the behaviour of alpha-naphthyl-acetate-esterases on hypothalamus, neurohypophysis, adrenal and parotid glands of rats had been examined against aldehydes, organic solution-mediators and anorganic salts. It had shown a different sensitiveness, the esterases of tanycytes, nerve cells and pituicytes acted more sensitive than those of the adrenal cortex and parotid gland. The differences seen on the solution-mediators were less; on metal salts from different groups of periodical system which applied, the most intense blocking effect was found in the nerve cells. The esterases of tanycytes and the immediately extensively reacting pituicytes, as well as the adrenal cortex esterases reacted essentially less sensitive, the gland cells of parotid even almost not at all. The arguments of this behaviour are discussed and pointed out with different complexity of alpha-naphthylacetate splitting enzymes on individual organs.

A complication of nasogastric tube removal.

Numerous complications associated with the use of nasogastric tubes have been reported. The most common of these complications result from their misdirection during insertion. We report a case in which the mercury tip of a nasogastric tube became lodged within the nasal cavity during removal. This required extraction by an otolaryngologist and resulted in a delay of discharge. The spectrum of complications associated with nasogastric tube use and recommendations for safe removal are discussed.

Changes in medical stability upon admission to a rehabilitation unit.

The implementation of Medicare's prospective payment system in acute care has coincided with a steady increase in medically unstable admissions to our freestanding rehabilitation facility. We investigated the consequences of these admissions by collecting medical information regarding transfers beginning in 1983. Patients requiring transfer back to the acute setting within 1 day of admission were considered medically unstable and their charts were reviewed. The number of patients requiring transfer back within 1 day increased from 1.5% of all first admissions to 3.1% in 1988 (Mantel - Haenszel chi 2 = 8.03, (df = 1), p < .01), but the increase among Medicare patients alone was not significant. This progressive increase was most pronounced in the cerebrovascular accident and spinal cord injury populations. Beginning in 1988, an intensified preadmission evaluation program was implemented, resulting in a significant decline in unstable patient transfers from hospitals where our consultants were on staff. Physiatric consultations at referral institutions decreased the number of unstable patients at admission.

Functional outcome following rehabilitation of the cancer patient.

OBJECTIVE: To identify impairments resulting from cancer or its treatment in patients undergoing inpatient rehabilitation, to assess the extent of functional gains, and to determine if cancer type, ongoing radiation treatment, or the presence of metastatic disease influences functional improvement. DESIGN AND SETTING: A retrospective, case series of cancer patients undergoing inpatient rehabilitation at a free-standing, university-affiliated rehabilitation hospital. PARTICIPANTS: A referred sample of 159 patients admitted because of functional impairments resulting from cancer or its treatment during a 2-year time period. INTERVENTION: Comprehensive inpatient rehabilitation. MAIN OUTCOME MEASURE: Functional status as measured by the motor score of the Functional Independence Measure. RESULTS: Significant functional gains were made between admission (mean = 42.9) and discharge (mean = 56.0; p < .001), with all cancer subgroups making similar gains. The presence of metastatic disease did not influence functional outcome, and those patients receiving radiation actually made larger functional improvements (p = .025). CONCLUSION: Individuals impaired by cancer or its treatment benefit from inpatient rehabilitation. The presence of metastatic disease or ongoing radiation should not preclude participation.

Functional outcomes of persons with brain tumors after inpatient rehabilitation.

OBJECTIVE: To assess the extent of functional gains measured before and after inpatient rehabilitation in patients who have primary or metastatic brain tumors, and to identify whether the tumor type, recurrent tumor, or ongoing radiation influences outcomes. DESIGN: Retrospective, descriptive study. SETTING: A free-standing university-affiliated rehabilitation hospital. PARTICIPANTS: A referred sample of 132 persons, all with functional impairments from a brain tumor and discharged from inpatient rehabilitation during a 3-year time period. INTERVENTION: Comprehensive inpatient rehabilitation. MAIN OUTCOME MEASURES: Functional status and rate of functional improvement (gain) as measured by the FIM instrument and FIM efficiency. RESULTS: Mean FIM efficiencies +/- standard deviation for motor (.82 +/-.69) and cognitive (.15 +/-.24) functions were equivalent across primary and metastatic tumor types (F =.42, df = 3,103, p = NS; F =.45, df = 2,104, p = NS, respectively); patients with metastatic disease had a significantly shorter length of stay at 18 +/- 12.3 days (t30,6 = 2.3, p =.03). Patients who received radiation during rehabilitation had a significantly greater (F = 4.1, df = 1,105, p <.05) motor efficiency score (1 +/-.79) than those who did not (.78 +/- 0.7). Patients with recurrent tumors made FIM cognitive changes equivalent to those of persons undergoing rehabilitation after their initial diagnosis, but their motor efficiency scores were significantly smaller (.55 +/-.39 vs.98 +/-.68, respectively) (F = 5.77, df = 1,85, p =.018), which reflected a significantly smaller FIM motor change. CONCLUSIONS: Metastatic or primary brain tumor type does not affect the efficiency of functional improvement during inpatient rehabilitation. Patients receiving concurrent radiation therapy make greater functional improvement per day than those not receiving radiation. Patients with recurrent tumors make significantly smaller functional motor gains than those completing inpatient rehabilitation after the tumor's initial diagnosis.

Repeated dosing of botulinum toxin type A for upper limb spasticity following stroke.

The authors evaluated the long-term efficacy and safety of botulinum toxin type A (BTX-A) in poststroke spasticity patients who completed a 12-week placebo-controlled study and received multiple open-label treatments with 200 to 240 U BTX-A for 42 weeks. Significant and sustained improvements were observed for Disability Assessment and Ashworth scores. Adverse events were generally mild. This extension of a double-blind study demonstrates that repeated treatments of BTX-A significantly improve function and tone in spasticity.