Telehealth Program for Infants at Risk of Cerebral Palsy during the Covid-19 Pandemic: A Pre-post Feasibility Experimental Study.

Aim: To verify the effects of a telerehabilitation program for infants at high risk for Cerebral Palsy (CP) during the COVID-19 pandemic.Method: Longitudinal study. Infants were aged 3-18 months corrected age, at risk of developmental delay. The General Movement Assessment or a neurologic examination were performed to identify the risk of CP. Motor function was assessed using the Gross Motor Function Measure-88 (GMFM-88) and the Alberta Infant Motor Scale (AIMS). Caregivers of infants at high risk of CP applied a home-based program supervised by a Physical therapist, five times a week over 12 weeks. The program included guidance for optimal positioning, optimization of goal-directed activities, environmental enrichment, and educational strategies.Results: 100 infants at risk for delayed motor development were recruited. Eighteen infants were classified at high risk of CP, and 10 families completed telerehabilitation (83% final retention rate). No adverse events were reported. Adherence to the telecare program was high (90%). The costs were low. We found increased scores for all dimensions and the total score of the GMFM-88, and the AIMS percentile at the end of the intervention. Most infants presented a clinically significant change for the GMFM-88.Conclusions: The telecare program was feasible.

Hyperbaric oxygen therapy mitigates left ventricular remodeling, upregulates MMP-2 and VEGF, and inhibits the induction of MMP-9, TGF-ß1, and TNF-α in streptozotocin-induced diabetic rat heart.

AIMS: Hyperbaric oxygen (HBO) therapy has been widely used for the adjunctive treatment of diabetic wounds, and is currently known to influence left ventricular (LV) function. However, morphological and molecular repercussions of the HBO in the diabetic myocardium remain to be described. We aimed to investigate whether HBO therapy would mitigate adverse LV remodeling caused by streptozotocin (STZ)-induced diabetes. MAIN METHODS: Sixty-day-old Male Wistar rats were divided into four groups: Control (n = 8), HBO (n = 7), STZ (n = 10), and STZ + HBO (n = 8). Diabetes was induced by a single STZ injection (60 mg/kg, i.p.). HBO treatment (100% oxygen at 2.5 atmospheres absolute, 60 min/day, 5 days/week) lasted for 5 weeks. LV morphology was evaluated using histomorphometry. Gene expression analyzes were performed for LV collagens I (Col1a1) and III (Col3a1), matrix metalloproteinases 2 (Mmp2) and 9 (Mmp9), and transforming growth factor-ß1 (Tgfb1). The Immunoexpression of cardiac tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) were also quantified. KEY FINDINGS: HBO therapy prevented LV concentric remodeling, heterogeneous myocyte hypertrophy, and fibrosis in diabetic rats associated with attenuation of leukocyte infiltration. HBO therapy also increased Mmp2 gene expression, and inhibited the induction of Tgfb1 and Mmp9 mRNAs caused by diabetes, and normalized TNF-α and VEGF protein expression. SIGNIFICANCE: HBO therapy had protective effects for the LV structure in STZ-diabetic rats and ameliorated expression levels of genes involved in cardiac collagen turnover, as well as pro-inflammatory and pro-angiogenic signaling.

CmyoSize: An ImageJ macro for automated analysis of cardiomyocyte size in images of routine histology staining.

BACKGROUND: Cardiomyocyte size histomorphometry is widely required in myocardial remodeling research, but it relies on subjective, time-consuming manual tracing. We aimed to present the CmyoSize, a Fiji/ImageJ macro that reproducibly measures the transnuclear cross-sectional size of cardiomyocytes in multiple H&E images. METHODS: CmyoSize output per image are: mean cross-sectional area (CSA), CSA's local standard deviation (LSD), mean width, and width's LSD. CmyoSize was validated against measurements of an expert examiner, using myocardium micrographs (400-fold magnification) from rats treated with hyperbaric oxygen (HBO), streptozotocin (STZ), as well as control rats (five images/heart, five rats/group). RESULTS: CmyoSize achieved high cardiomyocyte detection precision (95.17 ± 1.11%) and it analyzed each image at least 30-times faster than expert examiner (8.44 ± 0.17 s vs. 266.70 ± 25.15 s). Bland-Altman analyses showed no meaningful bias ( ± 95% confidence interval) between both methods: mean CSA = 1.88 ± 6.83 µm2, CSA's LSD = -4.55 ± 5.07 µm2; mean width = -0.02 ± 0.22 µm; width's LSD = -0.16 ± 0.17 µm. Pearson's r ranged from 0.85 to 0.94 (P < 0.0001). CmyoSize revealed homogenous cardiomyocyte hypertrophy in HBO-treated animals and STZ-induced heterogeneous hypertrophy. CONCLUSION: Fully automated, standardized cardiomyocyte size quantification in H&E images using CmyoSize is feasible, accurate, and time-efficient.

Magnitude and Clinical Predictors of Blood Pressure Changes in Patients Undergoing Hyperbaric Oxygen Therapy: A Retrospective Study.

Hyperbaric oxygen therapy (HBOT) is widely used to treat several pathologies. The hemodynamic changes during HBOT, particularly the magnitude of arterial blood pressure (ABP) increase, are not completely understood. No clinical predictors for HBOT-induced ABP increase have been described. The purpose of this study was to quantify ABP changes in patients undergoing HBOT and to examine their predictors. This retrospective longitudinal cohort study examined 3291 elective HBOT sessions. Non-invasive ABP was recorded before and after each session. The primary outcome was to quantify the HBOT-induced ABP rise. The secondary outcome was to determine the ABP-rise predictors among demographic and clinical variables. Overall, ABP increased significantly after HBOT; this finding was more evident in the hypertensive subgroup compared to the normotensive one (+6 vs. +16.2 mmHg). Clinical predictors of significant post-HBOT ABP change were history of hypertension and pre-session baseline ABP classification. This study demonstrates an absolute HBOT-induced ABP rise. This change is clinically relevant in patients with history of hypertension. A higher baseline ABP seems a risk factor for clinically relevant ABP change. Pre-session ABP should be used clinically as an indicator for strict ABP monitoring during HBOT; future studies are recommended to explore the ABP optimization before starting an HBO treatment.

Hyperbaric Oxygen for Radiation Necrosis of the Brain.

INTRODUCTION: Hyperbaric oxygen therapy (HBOT) shows promising results in treating radionecrosis (RN) but there is limited evidence for its use in brain RN. The purpose of this study is to report the outcomes of using HBOT for symptomatic brain RN at a single institution. METHODS: This was a retrospective review of patients with symptomatic brain RN between 2008 and 2018 and was treated with HBOT. Demographic data, steroid use, clinical response, radiologic response and toxicities were collected. The index time for analysis was the first day of HBOT. The primary endpoint was clinical improvement of a presenting symptom, including steroid dose reduction. RESULTS: Thirteen patients who received HBOT for symptomatic RN were included. The median time from last brain radiation therapy to presenting symptoms of brain RN was 6 months. Twelve patients (92%) had clinical improvement with median time to symptom improvement of 33 days (range 1-109 days). One patient had transient improvement after HBOT but had recurrent symptomatic RN at 12 months. Of the eight patients with evaluable follow-up MRI, four patients had radiological improvement while four had stable necrosis appearance. Two patients had subsequent deterioration in MRI appearances, one each in the background of initial radiologic improvement and stability. Median survival was 15 months with median follow-up of 10 months. Seven patients reported side effects attributable to HBOT (54%), four of which were otologic in origin. CONCLUSIONS: HBOT is a safe and effective treatment for brain RN. HBOT showed clinical and radiologic improvement or stability in most patients. Prospective studies to further evaluate the effectiveness and side effects of HBOT are needed.

Utilisation de l'oxygénothérapie hyperbare à la suite de séances de radiothérapie entraînant la mort du tissu cérébral. Introduction: Si l'oxygénothérapie hyperbare (OHB) laisse entrevoir des résultats prometteurs dans le traitement des radionécroses (RN), les preuves demeurent limitées quant à son utilisation dans le cas de RN du cerveau. L'objectif de cette étude est de présenter des résultats de recherche liés, dans un seul établissement de santé, à l'utilisation de l'OHB dans le cas de RN symptomatiques du cerveau. Méthodes: Pour ce faire, nous avons effectué une analyse rétrospective des dossiers de patients atteints de RN symptomatiques du cerveau entre 2008 et 2018 et ayant été traités lors de séances d'OHB. Nous avons aussi recueilli des données de nature démographique et d'autres portant sur l'utilisation de stéroïdes, sur la réponse clinique et radiologique des patients et sur les toxicités. Le point de départ (index time) de notre étude a été la première séance d'OHB alors que son principal indicateur de résultat a été l'amélioration sur le plan clinique d'un symptôme particulier, ce qui a inclus une réduction des doses de stéroïdes. Résultats: Au total, treize patients atteints de RN symptomatiques ont été inclus dans cette étude. Le temps médian entre une ultime séance de radiothérapie et l'apparition de symptômes de RN a été de 6 mois. Douze patients (92 %) ont donné à voir une amélioration de leur état médical, la période médiane d'amélioration de leurs symptômes étant de 33 jours (étendue : 1­109 jours). On a observé chez un seul patient une amélioration transitoire à la suite de séances d'OHB, les symptômes de RN étant réapparus au douzième mois. Sur les huit patients ayant subi un examen d'imagerie de suivi, quatre d'entre eux ont montré des signes d'amélioration sur le plan radiologique tandis que quatre autres ont donné à voir une RN stable. Fait à noter, deux patients chez qui l'on avait observé une amélioration radiologique initiale ou une stabilité de leur état ont montré une détérioration ultérieure à la suite d'un examen d'IRM. Le taux de survie médian de ces patients et leur suivi médian ont été respectivement de 15 mois et de 10 mois. Enfin, sept d'entre eux ont signalé des effets secondaires attribuables à l'OHB, dont quatre d'origine otologique. Conclusions: L'OHB demeure un traitement efficace et sécuritaire dans le cas des RN du cerveau. Elle a permis d'observer chez la plupart des patients une amélioration clinique et radiologique ou à tout le moins une stabilité de leurs symptômes. Cela dit, des études prospectives sont nécessaires afin de pouvoir évaluer plus en profondeur son efficacité et ses effets secondaires.

Palmar grasp behavior in full-term newborns in the first 72 hours of life.

BACKGROUND: The palmar grasp behavior is one of the items of an infant's routine neurological tests. Its exacerbated presence after the fifth month of age or absence in the first day after birth is an important sign of neuro-sensorimotor disorders. This study aimed to describe the palmar grasp behavior of full-term newborns in the first 72 h of life. METHODS: This nonrandomized cross-sectional developmental study included 219 typical newborns aged 12-2 4h, 25-48 h and 49-72 h. Three measurements were performed with newborns in the supine position, recording the palmar grasp time and strength. Statistical analysis was applied with significant level of p<0.05. RESULTS: Higher palmar grasp strength was observed in newborns aged 49-72 h compared to newborns aged 12-24 h and 25-48 h (F=7.42, p=0.01). There was significant difference in palmar grasp strength between hands (F=6.55, p=0.01), only in 12-24h, with greater strength in the left hand (t=-2.43, p=0.01), and difference in palmar grasp between strength (F=18.7, p=0.01) with greater strength in females (t=-5.40, p=0.01) only at the age 48-72 h. CONCLUSIONS: It was concluded that the palmar grasp behavior modifies in the first 72 h of life.