Efficacy of Multisensory Technology in Post-Stroke Cognitive Rehabilitation: A Systematic Review.

Post-stroke, in addition to sensorimotor signs and symptoms, could lead to cognitive deficits. Theories of embodiment stress the role of sensorimotor system and multisensory integration in sustaining high-order cognitive domains. Despite conventional post-stroke cognitive rehabilitation being effective, innovative technologies could overcome some limitations of standard interventions and exploit bodily information during cognitive rehabilitation. This systematic review aims to investigate whether 'multisensory technologies' compared to usual care treatment can be a viable alternative for cognitive rehabilitation. By applying PRISMA guidelines, we extracted data and assessed the bias of 10 studies that met the required criteria. We found that multisensory technologies were at least comparable to standard treatment but particularly effective for attention, spatial cognition, global cognition, and memory. Multisensory technologies consisted principally of virtual reality alone or combined with a motion tracking system. Multisensory technologies without motion tracking were more effective than standard procedures, whereas those with motion tracking showed balanced results for the two treatments. Limitations of the included studies regarded the population (e.g., no study on acute stroke), assessment (e.g., lack of multimodal/multisensory pre-post evaluation), and methodology (e.g., sample size, blinding bias). Recent advancements in technological development and metaverse open new opportunities to design embodied rehabilitative programs.

Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases: a case series study.

BACKGROUND: Venous thromboembolism (VTE) and brain metastases (MTS) are significant clinical problems in the cancer patient population. Brain MTS and deep vein thrombosis are life-threatening conditions because of the risk of fatal endocranic hypertension and pulmonary embolism. Low molecular weight heparin (LMWH) is a major treatment for cancer patients suffering from VTE with regard to the management of the acute phase and subsequent secondary prophylaxis. Treatment with anticoagulants is feared because of the risk of triggering a massive intracranial hemorrhage. METHODS: The medical records of patients with hypercoagulability-related complications and carrying brain MTS treated with LMWH, in a 10-year period, were scrutinized. The authors aimed to focus on the occurrence of intracranial hemorrhage in anticoagulated patients; furthermore, data were collected with regard to the characteristics of the administered LMWHs along with the duration and dosing of the anticoagulative treatment. RESULTS: A total of 38 patients (pts) carrying an intracranial metastatic tumor were administered LMWHs: calcium nadroparin (32 pts); enoxaparin (2 pts); reviparin (2 pts); parnaparin (2 pts). Reason for LMWH therapy: deep vein thrombosis and/or pulmonary embolism (15 pts); superficial thrombophlebitis (15 pts); intracardiac thrombus (1 pt); mild DIC (5 pts); acute DIC (1 pt); Raynaud phenomenon (1 pt); atrial fibrillation (1 pt). Median duration of LMWH therapy: 13 weeks (range 1-52). None of the patients developed clinical and/or radiographic findings imputable to intracranial hemorrhage. CONCLUSION: There is no standard medical approach for the management of patients who require anticoagulant treatment and are suffering from brain MTS. These patients as necessary, might be anticoagulated with LMWH and its dose reduction is to be considered.

Initial experience with hepatic intraarterial fotemustine and interferon alpha 2b combination for treatment of liver tumors.

BACKGROUND: Locoregional treatments represent a good option for patients suffering from hepatocellular carcinoma (HCC) not eligible for resection or transplantation. Locoregional approaches include a wide spectrum of therapeutic methods and hepatic intra-arterial drug infusion is also considered. Fotemustine is a chemotherapy drug usually administered intravenously according to standard administration schedules. Interferon alpha 2b (IFNα2b), a biological response modifier conventionally administered by a systemic route, has been employed in the treatment of both virus-related hepatitis and HCC. Nonetheless, both drugs can also be infused into the hepatic artery. PATIENTS AND METHODS: We report on five patients with liver cancer, not suitable for conventional therapies, treated with hepatic intra-arterial administration of fotemustine in combination with IFNα2b. They received fotemustine at a dose of 30 mg/m(2) and IFNα2b at a starting dose of 2,000,000 IU (increasing up to 3,000,000 IU for subsequent administrations) weekly for three consecutive weeks, followed by two weeks of rest. RESULTS: Among the patients suffering from HCC, the first patient showed a partial response, two patients had almost stable disease and one patient was not assessable. A patient with an intrahepatic biliary tract cancer experienced disease progression. CONCLUSION: The therapeutic regimen used showed acceptable tolerability profiles and lack of life-threatening side-effects. Further evaluation with a larger patient cohort will be required to clarify if fotemustine and IFNα2b administered into the hepatic artery could be beneficial in treating patients with HCC.

Successful administration of a low dose of calcium nadroparin in patients suffering from pulmonary embolism and brain metastases: a report of two cases.

OBJECTIVE: To focus on the optimal management of thromboembolic complication in patients who have undergone chemotherapy with concomitant brain metastases and referred to a Division of Clinical Oncology. BACKGROUND: Thromboembolic diseases are common events in cancer patients due to clotting activation by tumor cells. On the other hand, brain metastases are common complication of systemic cancers. Postmortem studies show that a quarter of patients dying from cancer have intracranial metastases. Brain metastases and pulmonary embolism are life-threatening conditions because of the risk of fatal endocranic hypertension and severe dyspnea. Calcium nadroparin is a low molecular weight heparin usually administered in patient with venous thromboembolism at a dose level of 180 IU/kg/daily. CASE SUMMARIES: The authors report the cases of two patients with intracranial metastases and pulmonary embolism-related dyspnea successfully treated with low dose of calcium nadroparin. A patient suffering from metastatic breast cancer and another one with metastatic nonsmall cell lung cancer were recently referred to our department because of severe dyspnea occurring during chemotherapy treatment. Both patients had cerebellar intracranial metastases. Massive pulmonary embolisms were shown by means of the computerized tomography. Despite the administration of a lower heparin dose than the usual one, around three-quarters of the calcium nadroparin daily conventional dose, quickly regressed dyspnea. Significant pulmonary embolism regression was revealed with computerized tomography scan within 8 weeks from the beginning of the thromboembolic complications. None of the patients showed any heparin treatment-related complications. CONCLUSION: The authors conclude that, with regard to cancer patients carrying brain metastases who require anti-coagulant therapy, increased risk of intracranial hemorrhage should be kept in mind. An initial low molecular weight heparin dose reduction could be effective, and safely administered, also in case of pulmonary embolism with severe dyspnea.

A crash-prediction model for multilane roads.

Considerable research has been carried out in recent years to establish relationships between crashes and traffic flow, geometric infrastructure characteristics and environmental factors for two-lane rural roads. Crash-prediction models focused on multilane rural roads, however, have rarely been investigated. In addition, most research has paid but little attention to the safety effects of variables such as stopping sight distance and pavement surface characteristics. Moreover, the statistical approaches have generally included Poisson and Negative Binomial regression models, whilst Negative Multinomial regression model has been used to a lesser extent. Finally, as far as the authors are aware, prediction models involving all the above-mentioned factors have still not been developed in Italy for multilane roads, such as motorways. Thus, in this paper crash-prediction models for a four-lane median-divided Italian motorway were set up on the basis of accident data observed during a 5-year monitoring period extending between 1999 and 2003. The Poisson, Negative Binomial and Negative Multinomial regression models, applied separately to tangents and curves, were used to model the frequency of accident occurrence. Model parameters were estimated by the Maximum Likelihood Method, and the Generalized Likelihood Ratio Test was applied to detect the significant variables to be included in the model equation. Goodness-of-fit was measured by means of both the explained fraction of total variation and the explained fraction of systematic variation. The Cumulative Residuals Method was also used to test the adequacy of a regression model throughout the range of each variable. The candidate set of explanatory variables was: length (L), curvature (1/R), annual average daily traffic (AADT), sight distance (SD), side friction coefficient (SFC), longitudinal slope (LS) and the presence of a junction (J). Separate prediction models for total crashes and for fatal and injury crashes only were considered. For curves it is shown that significant variables are L, 1/R and AADT, whereas for tangents they are L, AADT and junctions. The effect of rain precipitation was analysed on the basis of hourly rainfall data and assumptions about drying time. It is shown that a wet pavement significantly increases the number of crashes. The models developed in this paper for Italian motorways appear to be useful for many applications such as the detection of critical factors, the estimation of accident reduction due to infrastructure and pavement improvement, and the predictions of accidents counts when comparing different design options. Thus this research may represent a point of reference for engineers in adjusting or designing multilane roads.

Recombinant human erythropoietin stimulates angiogenesis and healing of ischemic skin wounds.

Wound healing in ischemic tissues such as flap margins due to inadequate blood supply is still a source of considerable morbidity in surgical practice. Adequate tissue perfusion is particularly important in wound healing. We investigated the effects of recombinant human erythropoietin (rHuEPO) on wound healing in an ischemic skin wound model. Sixty-three Sprague-Dawley rats were used. Normal incisional wound and H-shaped double flaps were used as the wound models. Animals were treated with rHuEPO (400 IU/kg) or its vehicle. Rats were killed on different days (3, 5, and 10 days after skin injury) and the wounded skin tissues were used for immunohistochemistry and for analysis of vascular endothelial growth factor content and collagen content. Tissue transglutaminase immunostaining of histological specimens was used as a vascular marker to determine the level of microvessel density. The results showed a higher level of vascular endothelial growth factor protein and an increased microvessel density in ischemic wounds with rHuEPO treatment than the normal incisional wounds and ischemic control wounds. Collagen content was higher in the incisional wounds and in the ischemic wounds with rHuEPO treatment compared with the ischemic control wounds. Our results suggest that erythropoietin may be an effective therapeutic approach in improving healing in ischemic skin wounds.

Oral administration of a soy extract improves endothelial dysfunction in ovariectomized rats.

Effects of oral administration for 4 weeks of a soy fraction with mainly isoflavones (Glycine max, Leguminosae) (SOYPH; 5 mg/kg) on vascular dysfunction induced by bilateral ovariectomy (OVX) in rats were studied. We evaluated vascular reactivity of aortic rings after acetylcholine (ACh 10 nM-10 microM), sodium nitroprussiate (SN 15 - 30 nM) and NG-L-arginine (L-NMA; 10 - 100 microM). Uterine weight and nitric oxide synthase (NOS) activity were also investigated. The same parameters were observed after 4 weeks treatment with 17beta-estradiol. In OVX rats endothelial-dependent vascular responses were changed: reduction of induced contraction ( L-NMA 100 mM: sham OVX 2.1 +/- 0.2 g/mg tissue; OVX 1.7 +/- 0.4 g/mg tissue). Ovariectomy produced a reduction of constitutive NOS activity. Uterine weight was increased in animals treated with 17beta-estradiol but not with SOYPH. Either SOYPH or 17beta-estradiol produced a similar improvement of endothelial dysfunction and increased NOS activity. Our data suggest that soy isoflavones produce an improvement of endothelial dysfunction induced by ovariectomy so as 17beta-estradiol, but probably without changes in reproductive system.

Erythropoietin prevents cognition impairment induced by transient brain ischemia in gerbils.

Erythropoietin has recently been studied for its role in the central nervous system (CNS). It has been shown to exert neuroprotective effects in different models of brain injury. We studied whether neuroprotective effects assessed from the reduction of neuronal loss after transient brain ischemia are associated to the preservation of learning ability. Recombinant human erythropoietin (0.5-25 U) was injected in the lateral cerebral ventricle of gerbils that are subjected to temporary (3 min) bilateral carotid occlusion. Post-ischemic histological evaluation of CA1 area neuronal loss and passive avoidance test were performed. Treatment with recombinant human erythropoietin significantly reduced delayed neuronal death in the CA1 area of the hippocampus and prevented cognition impairment in the passive avoidance test. These data indicate that recombinant human erythropoietin neuroprotective effects in brain ischemia are associated with the preservation of learning function.