Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial.

PURPOSE: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.

Chemotherapy-induced oral mucositis is associated with detrimental bacterial dysbiosis.

BACKGROUND: Gastrointestinal mucosal injury (mucositis), commonly affecting the oral cavity, is a clinically significant yet incompletely understood complication of cancer chemotherapy. Although antineoplastic cytotoxicity constitutes the primary injury trigger, the interaction of oral microbial commensals with mucosal tissues could modify the response. It is not clear, however, whether chemotherapy and its associated treatments affect oral microbial communities disrupting the homeostatic balance between resident microorganisms and the adjacent mucosa and if such alterations are associated with mucositis. To gain knowledge on the pathophysiology of oral mucositis, 49 subjects receiving 5-fluorouracil (5-FU) or doxorubicin-based chemotherapy were evaluated longitudinally during one cycle, assessing clinical outcomes, bacterial and fungal oral microbiome changes, and epithelial transcriptome responses. As a control for microbiome stability, 30 non-cancer subjects were longitudinally assessed. Through complementary in vitro assays, we also evaluated the antibacterial potential of 5-FU on oral microorganisms and the interaction of commensals with oral epithelial tissues. RESULTS: Oral mucositis severity was associated with 5-FU, increased salivary flow, and higher oral granulocyte counts. The oral bacteriome was disrupted during chemotherapy and while antibiotic and acid inhibitor intake contributed to these changes, bacteriome disruptions were also correlated with antineoplastics and independently and strongly associated with oral mucositis severity. Mucositis-associated bacteriome shifts included depletion of common health-associated commensals from the genera Streptococcus, Actinomyces, Gemella, Granulicatella, and Veillonella and enrichment of Gram-negative bacteria such as Fusobacterium nucleatum and Prevotella oris. Shifts could not be explained by a direct antibacterial effect of 5-FU, but rather resembled the inflammation-associated dysbiotic shifts seen in other oral conditions. Epithelial transcriptional responses during chemotherapy included upregulation of genes involved in innate immunity and apoptosis. Using a multilayer epithelial construct, we show mucositis-associated dysbiotic shifts may contribute to aggravate mucosal damage since the mucositis-depleted Streptococcus salivarius was tolerated as a commensal, while the mucositis-enriched F. nucleatum displayed pro-inflammatory and pro-apoptotic capacity. CONCLUSIONS: Altogether, our work reveals that chemotherapy-induced oral mucositis is associated with bacterial dysbiosis and demonstrates the potential for dysbiotic shifts to aggravate antineoplastic-induced epithelial injury. These findings suggest that control of oral bacterial dysbiosis could represent a novel preventive approach to ameliorate oral mucositis.

Phototherapy for Vitiligo: A Systematic Review and Meta-analysis.

Importance: References to the expected treatment response to phototherapy would be helpful in the management of vitiligo because phototherapy requires long treatment durations over several months. Objective: To estimate the treatment response of vitiligo to phototherapy. Data Sources: A comprehensive database search of MEDLINE, EMBASE, and the Cochrane library from inception to January 26, 2016, was performed for all prospective studies. The main keywords used were vitiligo, phototherapy, psoralen, PUVA, ultraviolet, NBUVB, and narrowband. Study Selection: All prospective studies reporting phototherapy outcome for at least 10 participants with generalized vitiligo were included. Of 319 studies initially identified, the full texts of 141 studies were assessed for eligibility, and 35 were finally included in the analysis. Of these, 29 studies included 1201 patients undergoing narrowband UV-B (NBUVB) phototherapy, and 9 included 227 patients undergoing psoralen-UV-A (PUVA) phototherapy. Data Extraction and Synthesis: Two reviewers independently extracted the following data: study design, number and characteristics of the participants, phototherapy protocol, and rate of repigmentation based on the quartile scale. Single-arm meta-analyses were performed for the NBUVB and PUVA groups. Sample size-weighted means were calculated using a random-effects model for the repigmentation rates of the included studies. Main Outcomes and Measures: The primary outcomes were at least mild (≥25%), at least moderate (≥50%), and marked (≥75%) responses on a quartile scale. Response rates were calculated as the number of participants who showed the corresponding repigmentation divided by the number of all participants enrolled in the individual studies. Results: The meta-analysis included 35 unique studies (1428 unique patients). For NBUVB phototherapy, an at least mild response occurred in 62.1% (95% CI, 46.9%-77.3%) of 130 patients in 3 studies at 3 months, 74.2% (95% CI, 68.5%-79.8%) of 232 patients in 11 studies at 6 months, and 75.0% (95% CI, 60.9%-89.2%) of 512 patients in 8 studies at 12 months. A marked response was achieved in 13.0% (95% CI, 2.1%-23.9%) of 106 patients in 2 studies at 3 months, 19.2% (95% CI, 11.4%-27.0%) of 266 patients in 13 studies at 6 months, and 35.7% (95% CI, 21.5%-49.9%) of 540 patients in 9 studies at 12 months. For PUVA phototherapy, an at least mild response occurred in 51.4% (95% CI, 28.1%-74.7%) of 103 patients in 4 studies at 6 months and 61.6% (95% CI, 20.2%-100%) of 72 patients in 3 studies at 12 months. In the subgroup analyses, marked responses were achieved on the face and neck in 44.2% (95% CI, 24.2%-64.2%), on the trunk in 26.1% (95% CI, 8.7%-43.5%), on the extremities in 17.3% (95% CI, 8.2%-26.5%), and on the hands and feet in none after at least 6 months of NBUVB phototherapy. Conclusions and Relevance: Long-duration phototherapy should be encouraged to enhance the treatment response in vitiligo. The greatest response is anticipated on the face and neck.

The efficacy of 308-nm excimer laser/light (EL) and topical agent combination therapy versus EL monotherapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials (RCTs).

BACKGROUND: Combination therapies of excimer laser/light (EL) and various topical agents are widely used in the treatment of vitiligo. OBJECTIVE: We sought to compare the efficacy of EL and topical agent combination therapy versus EL monotherapy for vitiligo. METHODS: Manual searches of reference lists and computerized searches of the MEDLINE, EMBASE, and Cochrane library (from inception through December 15, 2014) were conducted to identify randomized controlled trials that assessed the efficacy of EL alone or in combination with topical agents for vitiligo. The primary outcome was treatment success (≥75% repigmentation), and the secondary outcome was treatment failure (<25% repigmentation); meta-analyses were performed when possible. RESULTS: We analyzed 8 randomized controlled trials comprising a total of 425 patches/patients. The combination of EL and topical calcineurin inhibitors (4 studies: relative risk 1.93, 95% confidence interval 1.28-2.91; number needed to treat 4.5, 95% confidence interval 2.9-10) was superior to EL monotherapy for vitiligo. There was insufficient evidence to support beneficial effects of topical vitamin-D3 analogs (3 studies) and corticosteroids (1 study). LIMITATIONS: These findings are based on small numbers of randomized controlled trials and heterogeneities among included studies are another limitation. CONCLUSION: Topical calcineurin inhibitors in conjunction with EL are more effective compared with EL monotherapy.

Dysbiosis and Immune Dysregulation in Outer Space.

In space, the lifestyle, relative sterility of spaceship and extreme environmental stresses, such as microgravity and cosmic radiation, can compromise the balance between human body and human microbiome. An astronaut's body during spaceflight encounters increased risk for microbial infections and conditions because of immune dysregulation and altered microbiome, i.e. dysbiosis. This risk is further heightened by increase in virulence of pathogens in microgravity. Health status of astronauts might potentially benefit from maintaining a healthy microbiome by specifically managing their diet on space in addition to probiotic therapies. This review focuses on the current knowledge/understanding of how spaceflight affects human immunity and microbiome.

Effective dosage and administration schedule of oral alendronate for non-nociceptive symptoms in rats with chronic constriction injury.

We evaluated the efficacy of oral alendronate with different dosing regimens for non-nociceptive symptoms and osteoporosis in a sciatic nerve chronic constriction injury (CCI) model. Male Sprague-Dawley rats (n=60) were subdivided into sham control (SC) group and CCI groups, which were divided according to dosage and time of oral alendronate administration: no treatment (NT), low dosage early (LE), high dosage early (HE), low dosage late (LL) and high dosage late (HL). We measured the thickness and temperature of the hind paw, bone mineral density (BMD) of the tibia, along with tibia bone strength. On the 14th day post-CCI, the HE group showed significant reduction in thickness and temperature (P<0.001). On the 42nd day post-CCI, the HE group showed significant reduction in temperature compared to the NT group (P<0.001). Also, both HE and HL groups showed statistically significant increased tibia BMD (P<0.001), along with increase of tibia bone strength compared to the NT group. Based on these findings, early alendronate in high dosages is effective in the non-nociceptive symptoms; early and late alendronate in high dosages, are effective in preventing bone dystrophic changes in a CCI model.

Intrapartum obturator neuropathy diagnosed after cesarean delivery.

Several postpartum neurologic injuries have been described in detail, while obturator nerve injuries are rarely reported. We report a woman who had weakness of the right leg and groin pain after cesarean delivery under general anesthesia. Obturator neuropathy was confirmed by electromyography and no compressive lesion of the nerve was seen on magnetic resonance imaging. The patient was treated conservatively and followed until she recovered fully.