Cerebrolysin and Recovery After Stroke (CARS): A Randomized, Placebo-Controlled, Double-Blind, Multicenter Trial.

BACKGROUND AND PURPOSE: The aim of this trial was to investigate whether stroke patients who receive Cerebrolysin show improved motor function in the upper extremities at day 90 compared with patients who receive a placebo. METHODS: This study was a prospective, randomized, double-blind, placebo-controlled, multicenter, parallel-group study. Patients were treated with Cerebrolysin (30 mL/d) or a placebo (saline) once daily for 21 days, beginning at 24 to 72 hours after stroke onset. The patients also participated in a standardized rehabilitation program for 21 days that was initiated within 72 hours after stroke onset. The primary end point was the Action Research Arm Test score on day 90. RESULTS: The nonparametric effect size on the Action Research Arm Test score on day 90 indicated a large superiority of Cerebrolysin compared with the placebo (Mann-Whitney estimator, 0.71; 95% confidence interval, 0.63-0.79; P<0.0001). The multivariate effect size on global status, as assessed using 12 different outcome scales, indicated a small-to-medium superiority of Cerebrolysin (Mann-Whitney estimator, 0.62; 95% confidence interval, 0.58-0.65; P<0.0001). The rate of premature discontinuation was <5% (3.8%). Cerebrolysin was safe and well tolerated. CONCLUSIONS: Cerebrolysin had a beneficial effect on function and global outcome in early rehabilitation patients after stroke. Its safety was comparable with that of the placebo, suggesting a favorable benefit/risk ratio. Because this study was exploratory and had a relatively small sample size, the results should be confirmed in a large-scale, randomized clinical trial. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrialsregister.eu. Unique identifier: 2007-000870-21.

Ultrasonography techniques in the preoperative diagnosis of parotid gland tumors - an updated review of the literature.

Preoperative diagnosis of parotid tumors plays a crucial role in selecting and planning the surgical treatment. Ultrasound (US) with its modern techniques can contribute to the differential diagnosis of parotid tumors. This paper aims to achieve a comprehensive review of the ultrasound techniques used in the differential diagnosis of parotid tumors, based on the latest literature data. Considering that most parotid gland tumors are located in the superficial lobe, US is frequently the first imaging technique used for the diagnosis of parotid tumors. Sonoelastography can provide additional data on the elasticity of parotid tumors, but there is an overlap between malignant and benign parotid tumors parameters. Contrast-enhanced ultrasound adds value to conventional ultrasound and allows a more complete characterization of parotid tumors. Many authors have reported promising results using contrast-enhanced ultrasound in the differential diagnosis of parotid tumors. Multiparametric ultrasound with a careful and systematic approach usually allows an accurate differential diagnosis of parotid tumors.

Relation of achievement motives, satisfaction with life, happiness and oral health in Romanian university students.

PURPOSE: The objective of the present study was to investigate whether achievement motives, satisfaction with life and happiness are associated with oral health behaviour and perceived gingival status. METHODS: The present study sample consisted of 178 first-year medical students. The questionnaire included information about sociodemographic factors, behavioural variables, perceived oral health status, achievement motives (hope of success and fear of failure), satisfaction with life and subjective happiness scales. RESULTS: It was observed that individuals who presented higher values of satisfaction with life and happiness rated their gingival status as being very good/excellent and that individuals who presented higher values of hope of success reported to brush frequently. When the oral health behaviour was analysed, it was revealed that persons who brushed their teeth more than twice a day reported higher values of hope of success when compared with individuals who reported their toothbrushing frequency to be once a day or less. It was also revealed that persons who visited their clinician for check-ups reported higher values of subjective happiness. Multiple linear regression analyses showed that stress in everyday life and hope of success were positively associated with the toothbrushing frequency and that satisfaction with life was positively associated with the gingival health status. CONCLUSIONS: Hope of success and satisfaction with life should be considered as predictors of good oral health behaviour/status.

Self-reported oral health status, oral health-related behaviours, resilience and hope in Romania.

PURPOSE: The aim of the present study was to investigate whether resilience, hope, perceived oral health status and oral health-related behaviours were associated. MATERIALS AND METHODS: The study sample consisted of 198 first-year medical students in Romania. The questionnaire included information about sociodemographic factors, behavioural variables, perceived oral health status, resilience and hope. RESULTS: Women had more resilience and 'personal competence' than men (P < 0.05). Resilience and hope were correlated with perceived dental health (P < 0.01). Perceived dental health was related to current non-treated caries, satisfaction with the appearance of one's own teeth, toothache last time and resilience (P < 0.001). Age, gender, current extracted teeth, perceived gingival bleeding and hope were not independent distinguishing variables after adjustment for internal heterogeneity. When oral health behaviours (toothbrushing, flossing, mouthrinse frequency and pattern of dental visit) were evaluated, it was demonstrated that flossing frequency was correlated with resilience and hope (P < 0.01). CONCLUSIONS: The results suggested that resilience and hope might be a psychosocial risk marker that influences perceived oral health status and behaviours.

Cortical modulation of cardiac autonomic activity in ischemic stroke patients.

The cardiovascular system is regulated by the autonomic nervous system, under cortical modulation. Stroke can induce cardiac autonomic imbalance, therefore, causing secondary cardiovascular complications. Heart rate variability (HRV) analysis is a simple method to appraise the autonomic nervous function. The purpose of this study was to investigate the cardiac autonomic activity in patients that suffered an ischemic stroke in middle cerebral artery (MCA) territory. Using Biopac Acquisition System, we monitored ECG in rest condition and during Ewing's tests. From these measurements, HRV parameters (using time and frequency domain analysis) were determined in 20 right MCA and 20 left MCA ischemic stroke patients, in the first 6 months after the acute event. Data were compared with 20 age- and sex-matched healthy controls. All the patients were right handed. In ischemic stroke patients, HRV parameters were significantly modified compared to controls (p < 0.05) and we found asymmetric responses to different stimulation autonomic tests between right and left hemisphere. Parameters illustrating the parasympathetic predominance in time domain (RMSSD) and frequency domain (HF) analysis were higher in left hemisphere stroke compared to right hemisphere stroke patients (p < 0.01) in resting state. From Ewing's battery test, patients with left hemisphere ischemic stroke showed predominance of parasympathetic activity to deep breathing (p < 0.01), while HRV parameters in right hemisphere ischemic stroke patients described a reduced cardiac parasympathetic innervation (p < 0.01). Cardiac autonomic imbalance occurs more often after right hemisphere ischemic stroke. HRV study may highlight cardiac dysfunctions that increase the risk of cardiovascular complications and portends a poor long-term outcome.

Mirror therapy enhances upper extremity motor recovery in stroke patients.

The purpose of this study was to evaluate the effects of mirror therapy program in addition with physical therapy methods on upper limb recovery in patients with subacute ischemic stroke. 15 subjects followed a comprehensive rehabilitative treatment, 8 subjects received only control therapy (CT) and 7 subjects received mirror therapy (MT) for 30 min every day, five times a week, for 6 weeks in addition to the conventional therapy. Brunnstrom stages, Fugl-Meyer Assessment (upper extremity), the Ashworth Scale, and Bhakta Test (finger flexion scale) were used to assess changes in upper limb motor recovery and motor function after intervention. After 6 weeks of treatment, patients in both groups showed significant improvements in the variables measured. Patients who received MT showed greater improvements compared to the CT group. The MT treatment results included: improvement of motor functions, manual skills and activities of daily living. The best results were obtained when the treatment was started soon after the stroke. MT is an easy and low-cost method to improve motor recovery of the upper limb.

Selective laser melted titanium implants: a new technique for the reconstruction of extensive zygomatic complex defects / 대한악안면성형재건외과학회지

The restoration of extensive zygomatic complex defects is a surgical challenge owing to the difficulty of accurately restoring the normal anatomy, symmetry, proper facial projection and facial width. In the present study, an extensive post-traumatic zygomatic bone defect was reconstructed using a custom-made implant that was made with a selective laser melting (SLM) technique. The computer-designed implant had the proper geometry and fit perfectly into the defect without requiring any intraoperative adjustments. A one-year follow-up revealed a stable outcome with no complications.

Erratum to: Selective laser melted titanium implants: a new technique for the reconstruction of extensive zygomatic complex defects / 대한악안면성형재건외과학회지

After the "Competing interests" section in the original version of this article, "Acknowledgements" section should be inserted and read.

Erratum to: Selective laser melted titanium implants: a new technique for the reconstruction of extensive zygomatic complex defects / 대한악안면성형재건외과학회지

After the "Competing interests" section in the original version of this article, "Acknowledgements" section should be inserted and read.