Bringing rehabilitation home with an e-health platform to treat stroke patients: study protocol of a randomized clinical trial (RGS@home).

BACKGROUND: There is a pressing need for scalable healthcare solutions and a shift in the rehabilitation paradigm from hospitals to homes to tackle the increase in stroke incidence while reducing the practical and economic burden for patients, hospitals, and society. Digital health technologies can contribute to addressing this challenge; however, little is known about their effectiveness in at-home settings. In response, we have designed the RGS@home study to investigate the effectiveness, acceptance, and cost of a deep tech solution called the Rehabilitation Gaming System (RGS). RGS is a cloud-based system for delivering AI-enhanced rehabilitation using virtual reality, motion capture, and wearables that can be used in the hospital and at home. The core principles of the brain theory-based RGS intervention are to deliver rehabilitation exercises in the form of embodied, goal-oriented, and task-specific action. METHODS: The RGS@home study is a randomized longitudinal clinical trial designed to assess whether the combination of the RGS intervention with standard care is superior to standard care alone for the functional recovery of stroke patients at the hospital and at home. The study is conducted in collaboration with hospitals in Spain, Sweden, and France and includes inpatients and outpatients at subacute and chronic stages post-stroke. The intervention duration is 3 months with assessment at baseline and after 3, 6, and 12 months. The impact of RGS is evaluated in terms of quality of life measurements, usability, and acceptance using standardized clinical scales, together with health economic analysis. So far, one-third of the patients expected to participate in the study have been recruited (N = 90, mean age 60, days after stroke ≥ 30 days). The trial will end in July 2023. DISCUSSION: We predict an improvement in the patients' recovery, high acceptance, and reduced costs due to a soft landing from the clinic to home rehabilitation. In addition, the data provided will allow us to assess whether the prescription of therapy at home can counteract deterioration and improve quality of life while also identifying new standards for online and remote assessment, diagnostics, and intervention across European hospitals. TRIAL REGISTRATION: C linicalTrials.gov NCT04620707. Registered on November 3, 2020.

Different Cortical Gyrification Patterns in Alzheimer's Disease and Impact on Memory Performance.

OBJECTIVE: The study of cortical gyrification in Alzheimer's disease (AD) could help to further understanding of the changes undergone in the brain during neurodegeneration. Here, we aimed to study brain gyrification differences between healthy controls (HC), mild cognitive impairment (MCI) patients, and AD patients, and explore how cerebral gyrification patterns were associated with memory and other cognitive functions. METHODS: We applied surface-based morphometry techniques in 2 large, independent cross-sectional samples, obtained from the Alzheimer's Disease Neuroimaging Initiative project. Both samples, encompassing a total of 1,270 participants, were analyzed independently. RESULTS: Unexpectedly, we found that AD patients presented a more gyrificated entorhinal cortex than HC. Conversely, the insular cortex of AD patients was hypogyrificated. A decrease in the gyrification of the insular cortex was also found in older HC participants as compared with younger HC, which argues against the specificity of this finding in AD. However, an increased degree of folding of the insular cortex was specifically associated with better memory function and semantic fluency, only in AD patients. Overall, MCI patients presented an intermediate gyrification pattern. All these findings were consistently observed in the two samples. INTERPRETATION: The marked atrophy of the medial temporal lobe observed in AD patients may explain the increased folding of the entorhinal cortex. We additionally speculate regarding alternative mechanisms that may also alter its folding. The association between increased gyrification of the insular cortex and memory function, specifically observed in AD, could be suggestive of compensatory mechanisms to overcome the loss of memory function. ANN NEUROL 2020 ANN NEUROL 2020;88:67-80.

Patient perspectives on the acceptability of mHealth technology for remote measurement and management of epilepsy: A qualitative analysis.

BACKGROUND: Innovative uses of mobile health (mHealth) technology for real-time measurement and management of epilepsy may improve the care provided to patients. For instance, seizure detection and quantifying related problems will have an impact on quality of life and improve clinical management for people experiencing frequent and uncontrolled seizures. Engaging patients with mHealth technology is essential, but little is known about patient perspectives on their acceptability. The aim of this study was to conduct an in-depth qualitative analysis of what people with uncontrolled epilepsy think could be the potential uses of mHealth technology and to identify early potential barriers and facilitators to engagement in three European countries. METHOD: Twenty people currently experiencing epileptic seizures took part in five focus groups held across the UK, Italy, and Spain. Participants all completed written consent and a demographic questionnaire prior to the focus group commencing, and each group discussion lasted 60-120 min. A coding frame, developed from a systematic review of the previous literature, was used to structure a thematic analysis. We extracted themes and subthemes from the discussions, focusing first on possible uses of mHealth and then the barriers and facilitators to engagement. RESULTS: Participants were interested in mHealth technology as a clinical detection tool, e.g., to aid communication about seizure occurrence with their doctors. Other suggested uses included being able to predict or prevent seizures, and to improve self-management. Key facilitators to engagement were the ability to raise awareness, plan activities better, and improve safety. Key barriers were the potential for increased stigma and anxiety. Using familiar and customizable products could be important moderators of engagement. CONCLUSION: People with uncontrolled epilepsy think that there is a scope for mHealth technology to be useful in healthcare as a detection or prediction tool. The costs will be compared with the benefits when it comes to engagement, and ongoing work with patients and other stakeholders is needed to design practical resources.

Exploratory field study on the effect of Porcine circovirus 2 (PCV2) sow vaccination on serological, virological and reproductive parameters in a PCV2 subclinically infected sow herd.

BACKGROUND: This study sought to evaluate the effect of sow vaccination against Porcine circovirus 2 (PCV2) on reproductive parameters during two consecutive reproductive cycles. The study was performed in a PCV2 subclinical infected breeding herd (PCV2 circulation but absence of major reproductive problems). Ninety-four pregnant sows were primo-immunized with a commercial PCV2 vaccine and ninety-seven were injected with phosphate-buffered saline at 6 and 3 weeks before the first studied farrowing, and then boosted at 2 weeks before the second one. Blood samples were taken throughout the study to assess PCV2 DNA load and antibodies. At farrowing, main reproductive parameters and piglet vitality index were registered. In addition, in those litters with more than three mummified or stillborn piglets, microscopic examination and PCV2 antigen detection in foetal myocardium was done. RESULTS: Vaccinated sows showed significantly higher antibody levels compared to the non-vaccinated counterparts. PCV2 DNA was only detected at farrowing in 2 (4.2%) non-vaccinated sows. Vaccinated sows had 1.3 more live-born piglets per litter at the second cycle than non-vaccinated counterparts. Piglets from vaccinated sows had significantly higher (+ 12.7%) vitality score than the ones born from non-vaccinated sows. No PCV2 compatible lesions neither PCV2 antigen were detected in the tested foetal hearts. CONCLUSIONS: The present study represents a first attempt to demonstrate that PCV2 sow vaccination may have a positive influence on prolificacy and vitality of the offspring in a subclinical infected breeding herd. However, since reproductive outcomes at farm level may be affected by a number of factors, further studies would be needed to confirm this association.

Evaluation of natural porcine circovirus type 2 (PCV2) subclinical infection and seroconversion dynamics in piglets vaccinated at different ages.

This study aimed to determine the porcine circovirus type 2 (PCV2) serological and virological dynamics in piglets vaccinated at different ages in a PCV2 subclinical infection (PCV2-SI) scenario. Six hundred and forty-four 2 week-old healthy piglets were selected and distributed into four treatment groups: vaccination at 3, 6 or 10 weeks of age (3W-VAC, 6W-VAC and 10W-VAC groups, respectively) and unvaccinated pigs (NON-VAC group). Blood (n = 112 pigs) and oral fluid (OF) (n = 40 pens) samples were taken throughout the study to assess PCV2 load, humoral immunity and viral genotyping. Percentage of PCV2-DNA positive sera mainly raised by 10 weeks of age, being maximum at 14 weeks of age, and then started to decrease at 18 and 25 weeks of age. Specifically, PCV2 vaccination at 3 or 6 weeks of age yielded similar results, since they produced an earlier seroconversion and reduced, at different sampling points, the proportion of viremic animals in comparison to the unvaccinated group. In contrast, PCV2 vaccination at 10 weeks of age only achieved such reduction at 25 weeks of age; in this case, vaccination coincided with the increase of the percentage of viremic pigs in the population. Both serological techniques used in sera and OF offered similar results with a high and statistically significant correlation. In contrast, a higher percentage of PCV2 DNA positivity was detected in OF in comparison with sera. In conclusion, under the present study conditions, the optimal time for PCV2 piglet vaccination was at either 3 or 6 weeks of age.

Effects of Night-Time Use of Rotigotine on Nocturnal Symptoms in Parkinson's Disease.

Objectives. This open-label study assessed the efficacy and safety of exclusive night-time administration of transdermal rotigotine in patients with nocturnal and early morning PD symptoms. Methods. Patients with PD and nocturnal and early morning symptoms received transdermal rotigotine patches (2-16 mg/24 h) applied in the evening and removed in the morning for 3 months. Sleep disturbance was assessed with modified Parkinson's Disease Sleep Scale (PDSS-2). Other outcomes included a pain visual analogue scale (VAS) and short-form Parkinson's Disease Questionnaire (PDQ-8) for quality of life. Results. 74 patients completed treatment in this study. At the end of treatment, PDSS-2 total score had improved by mean 10.9 points from baseline (p < 0.001). All three PDSS-2 domain scores (sleep disturbances, nocturnal motor symptoms, and nocturnal symptoms) were also significantly improved by 41%, 56%, and 48%, respectively (p < 0.001). VAS-pain score decreased from 3.2 to 2.3 (p < 0.001). PDQ-8 score decreased from 23.8 to 18.1 (p < 0.001). The most frequently reported adverse events included nausea (9%), anxiety (4%), and dizziness (4%). Conclusions. Night-time administration of transdermal rotigotine is an effective and well tolerated treatment for nocturnal symptoms in patients with PD.

Serum haptoglobin dynamics in pigs vaccinated or not vaccinated against porcine circovirus type 2.

The present work describes the serum haptoglobin (Hp) dynamics in piglets vaccinated and non-vaccinated with a commercial porcine circovirus type 2 (PCV2) vaccine at 3 weeks of age, and its relationship with the average daily weight gain (ADWG). The field study was carried out on two farms (A and B) with a previous clinical history of PCV2-systemic disease (PCV2-SD). The aim of the study was to assess whether Hp could be used as a surrogate marker of PCV2 vaccine efficacy. PCV2 infection was confirmed by quantitative real time PCR (qPCR) in pigs from both farms, but PCV2-SD was only diagnosed in farm A. No statistically significant relation was found between serum Hp concentration and the percentage of qPCR positive animals and the treatment applied (PCV2 vaccination) in both farms. On the other hand, using linear regression analysis, a significant negative correlation between the area under the curve of Hp (AUCHp) and ADWG was observed for farm A (p < 0.00001) and B (p = 0.01). Based on the obtained determination coefficient (R2) values, AUCHp explained 20.0 and 11.6% of the observed ADWG for farms A and B, respectively. The present study supports that the measurement of acute phase proteins may be an indicator of ADWG in pig farms, but it was not apparently feasible to use the serum Hp concentration as a surrogate marker of PCV2 vaccine efficacy.

Post-weaning multisystemic wasting syndrome (PMWS) clinical expression under field conditions is modulated by the pig genetic background.

Post-weaning multisystemic wasting syndrome (PMWS) is a worldwide distributed disease of multifactorial origin and porcine circovirus type 2 (PCV2) has been identified as its essential infectious aetiology. Pig genetic background has been pointed to influence disease expression. In the present study, three different boar lines, namely A (100% Pietrain), B (50% Large White × 50% Pietrain) and C (25% Large White × 75% Duroc), were used to inseminate sows from the same genetic line (37.5% Large White × 37.5% Duroc × 25% Landrace) located on two PMWS-affected farms (farm-1 and farm-2). The PMWS clinical expression of their offspring was studied from weaning to slaughter, evaluating three parameters: total post-weaning mortality (PWM), PWM associated to PMWS (PMWS-PWM) and body weight (BW) evolution. The effect of other variables potentially related with PMWS, including sow and piglet PCV2 exposure, sow parity, piglet gender and piglet BW at weaning, were also considered in the study design. Overall, a total of 6.5% PWM and 4.3% PMWS-PWM occurred in the monitored farms. Pigs from boar line C showed the highest PWM (16.3%) and PMWS-PWM (12.4%), and the lowest BW; pigs from boar line A showed the lowest PWM (1.8%) and the highest BW. Furthermore, PWM was also higher in piglets from farm-2 and from multiparous sows. In farm-2, PMWS-PWM was higher in piglets from multiparous sows. Finally, BW was influenced by interactions between genetics and both farm and pig age, and was lower in piglets from farm-2. This study represents a consistent observation of the genetic background effect on PMWS clinical expression under field conditions.

Apoptosis of peripheral blood lymphocytes in Parkinson patients.

Neuronal cell death by apoptosis is a mechanism involved in Parkinson's disease and indirect signs of apoptosis have been found in brain neurons and blood lymphocytes. The present study was aimed to directly assess the presence of enhanced apoptosis in lymphocytes from 89 idiopathic Parkinson's disease patients, 33 untreated and 56 treated, compared with 33 healthy individuals. The study of both spontaneous and activation-induced apoptosis of T-lymphocyte subsets by annexin-V binding and flow cytometry showed that Parkinson patients increased the expression of Fas in circulating CD4(+) T cells, mainly "naive," that correlated with the decrease of these cells in blood. Spontaneous and activation-induced apoptosis of CD4(+) T-cell subsets were also significantly increased. Thus, in Parkinson patients, peripheral blood CD4(+) T cells have an increased susceptibility to apoptosis with Fas involvement. This fact explains the decrease in the number of CD4(+) T-cell subsets observed in Parkinson and could be related to the neurodegenerative process.

Laser evoked potentials and prepulse inhibition of the blink reflex in patients with Wallenberg's syndrome.

Spinothalamic tract lesions in patients with Wallenberg's syndrome can be demonstrated by abnormalities in the laser evoked potentials (LEPs) to stimulation of the affected side. However, before reaching the structures generating LEPs, laser stimuli can induce effects at a subcortical level. We examined LEPs and laser-induced prepulse inhibition of the blink reflex in seven patients with Wallenberg's syndrome within a month after the infarct. All patients had abnormally elevated thresholds for temperature and pain sensation, and for pinprick pain induced by laser stimuli, in the affected vs the non-affected side. LEPs to stimulation of the affected side were abnormal because of absent, reduced or delayed responses. However, the same laser stimuli that were unable to induce LEPs generated normal inhibition of the blink reflex response when applied 250ms before a trigeminal nerve electrical stimulus. The percentage inhibition induced in the R2 response of the blink reflex by laser stimulation of the affected side was not different from that induced by stimulation of the non-affected side, or in control subjects. These results are compatible with either a different pathway for prepulse inhibition and evoked potentials or a reduced energy requirement of the sensory input generating prepulse inhibition in comparison to that generating evoked potentials.