Clinical efficacy and safety of edaravone therapy in acute cerebral haemorrhage

Purpose: To evaluate the clinical efficacy and safety of edaravone in the treatment of acute cerebral haemorrhage (ACH). Methods: This study recruited 120 patients who developed ACH. The patients were divided into control and treatment groups with 60 patients per group. The control group underwent conventional treatment and the treatment group also received intravenous edaravone. The volumes of cerebral edema and cerebral hematoma, high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels, and Chinese Stroke Scale (CSS) score before and after treatment were compared between the two groups. Results: The respective cerebral edema volumes of the control and treatment groups decreased from 20.99 ± 12.09 and 21.80 ± 12.01 mL on day 0 to 11.23 ± 6.34 and 12.11 ± 5.98 mL at day 7 and 4.69 ± 4.03 and 4.64 ± 3.9 mL on day 14 (P < 0.05). The respective cerebral hematoma volumes of the control and treatment groups decreased from 18.98 ± 12.04 and 18.97 ± 12.07 mL on day 0 to 12.34 ± 6.57 and 11.89 ± 4.01 mL at day 7 and 9.49 ± 3.95 and 9.52 ± 3.96 mL on day 14. Compared with pretreatment, hs-CRP and IL-6 levels and CSS score of the two groups decreased significantly following treatment (p < 0.05); the differences in the cerebral edema and hematoma volumes of the two groups on days 7 and 14 were not significant (p > 0.05). The hs-CRP and IL-6 levels and CSS scores of the treatment group decreased appreciably (p < 0.05), while the incidence of adverse reactions in the treatment and control groups was 16.67 and 13.33 %, respectively, but the difference was not significant (p > 0.05). Conclusion: Edaravone shows remarkable clinical efficacy and safety with no obvious adverse reactions in the treatment of ACH. Therefore, its use is recommended.

Medición de la profundidad anestésica y memoria durante anestesia general mediante el cerebral state monitor (csm x06)

Este es un ensayo clínico controlado realizado en 327 pacientes ASA II, sometidas a cesárea, distribuidas aleatoriamente en dos grupos iguales para identificar las variaciones hemodinámicas y nivel metamérico, al aplicar Anestesia Intratecal con Lidocaína Isobárica al 2(AILI) comparada con Lidocaína Hiperbárica al 5(AILH), ambas a dosis de 80 mg. Resultados: la AILI, se mantuvo en determinadas metámeras sin sustancial variabilidad, comportamiento totalmente contrario a la AILH. Las diferencias estadísticas en la presión sistólica, diastólica, y frecuencia cardiaca, entre ambos tipos de anestesia no fueron significativas. La hipotensión se presentó en 32,9con AILI, y 54con AILH; siendo tratada con 2,26 mg (ñ 3.65) y 3,93 mg (ñ 4,26) de efedrina respectivamente. (p> 0.05). Con AILI se presentaron 4 casos de bloqueo raquídeo alto más dificultad respiratoria y, con AILH 3 casos, de los cuales solo 2 presentaron dificultad respiratoria. Conclusión: la AILI produce un bloqueo nervioso más predecible que la AILH. Los valores hemodinámicos y la incidencia de complicaciones, entre ambos anestésicos fueron semejantes

Double stent-retriever technique in endovascular treatment of middle cerebral artery saddle embolus

Ischemic stroke is a major public health problem worldwide, considered as the third most costly health condition in developed countries, with urgent reperfusion remaining the paramount goal for its treatment. In line with the results of recent randomized control trials, the introduction of stent retrievers was a major advancement in the treatment of stroke; however, interventionalists sometimes encounter thrombi not-retrievable by applying conventional techniques. In this article, we present a case treated by an innovative double-stent retrieval in Y-configuration that may potentially help other clinicians in similar situations.

Cerebral responses to innocuous somatic pressure stimulation following aerobic exercise rehabilitation in chronic pain patients: a functional magnetic resonance imaging study

Objective: The purpose of this research was to assess the functional brain activity and perceptual rating of innocuous somatic pressure stimulation before and after exercise rehabilitation in patients with chronic pain.

Materials and methods: Eleven chronic pain patients and eight healthy pain-free controls completed 12 weeks of supervised aerobic exercise intervention. Perceptual rating of standardized somatic pressure stimulation (2 kg) on the right anterior mid-thigh and brain responses during functional magnetic resonance imaging (fMRI) were assessed at pre- and postexercise rehabilitation.

Results: There was a significant difference in the perceptual rating of innocuous somatic pressure stimulation between the chronic pain and control groups (P=0.02) but no difference following exercise rehabilitation. Whole brain voxel-wise analysis with correction for multiple comparisons revealed trends for differences in fMRI responses between the chronic pain and control groups in the superior temporal gyrus (chronic pain > control, corrected P=0.30), thalamus, and caudate (control > chronic, corrected P=0.23). Repeated measures of the regions of interest (5 mm radius) for blood oxygen level-dependent signal response revealed trend differences for superior temporal gyrus (P=0.06), thalamus (P=0.04), and caudate (P=0.21). Group-by-time interactions revealed trend differences in the caudate (P=0.10) and superior temporal gyrus (P=0.29).

Conclusion: Augmented perceptual and brain responses to innocuous somatic pressure stimulation were shown in the chronic pain group compared to the control group; however, 12-weeks of exercise rehabilitation did not significantly attenuate these responses.

Minimising impairment: protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy

BACKGROUND: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone.

METHODS/DESIGN: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score ≥1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed.

DISCUSSION: This study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs.

Communication changes experienced by adults with cerebral palsy as they age

PURPOSE: Adults with cerebral palsy (CP) experience multiple, functional changes as they age, including changes to communication modes and methods that enable development and maintenance of relationships, communicative participation and quality-of-life. Little is known about the nature of communication changes experienced by this group. The aim of this study was to better understand how adults with CP experience changes in their communication abilities as they age and the subsequent psychosocial impact.

METHOD: Twenty adults with cerebral palsy aged 40-72 years with complex communication needs (CCN) participated in a series of in-depth interviews, framing their experiences of loss and grief throughout their lives. The impact of changing communication abilities emerged as an important area of focus. Data were analysed using constructivist grounded theory methodology.

RESULT: Themes arising from the participants' perceptions of their communication included experiencing communication change as a loss with subsequent impact on self-concept; and how communication is integral to the process of managing losses associated with older age.

CONCLUSION: Implications for speech-language pathologists working with older people with cerebral palsy and CCN include the need to understand the psychosocial impact of communication changes on social interaction, relationships and communicative participation. It is important to promote positive and meaningful communication options that maintain a coherent sense of self in addition to promoting functional communication skills and communicative participation.

Cerebral oxygenation in mechanically ventilated early cardiac arrest survivors: The impact of hypercapnia

BACKGROUND : Optimal cerebral oxygenation is considered fundamental to cerebral protection in cardiac arrest (CA) patients. Hypercapnia increases cerebral blood flow and may also improve cerebral oxygenation. It is uncertain, however, whether this effect occurs in mechanically ventilated early survivors of CA. METHODS: We enrolled mechanically ventilated resuscitated patients within 36 h of their cardiac arrest. We performed a prospective double cross-over physiological study comparing the impact of normocapnia (PaCO2 35-45 mmHg) vs. mild hypercapnia (PaCO2 45-55 mmHg) on regional cerebral tissue oxygen saturation (SctO2) assessed by near infrared spectroscopy (NIRS).RESULTS: We studied seven adult CA patients with a median time to return of spontaneous circulation of 28 min at a median of 26 h and 30 min after CA. During normocapnia (median EtCO2 of 32 mmHg [30-41 mmHg] and PaCO2 of 37 mmHg [32-45 mmHg]) the median NIRS-derived left frontal SctO2 was 61% [52-65%] and the right frontal SctO2 was 61% [54-68%]. However, during mild hypercapnia (median EtCO2 of 49 mmHg [40-57 mmHg] and PaCO2 of 52 mmHg [43-55 mmHg) the median left frontal SctO2 increased to 69% [59-78%] and the right frontal SctO2 increased to 73% [61-76%])(p = 0.001, for all comparisons). CONCLUSION: During the early post-resuscitation period, in mechanically ventilated CA patients, mild hypercapnia increases cerebral oxygenation as assessed by NIRS. Further investigations of the effect of prolonged mild hypercapnia on cerebral oxygenation and patient outcomes appear justified.

Design for placement of modified optodes to non-invasively map cerebral function

By using near infrared spectroscopy (NIRS) and by modifying the current Somanetics® optodes being used with the INVOS oximeter, the modified optodes are made to be fairly functional not only across the forehead, but across the hairy regions of the scalp as well. A major problem arises in the positioning of these optodes on the patients scalp and holding them in place while recording data. Another problem arises in the inconsistent repeatability of the trends displayed in the recorded data. A method was developed to facilitate the easy placement of these optodes on the patients scalp keeping in mind thepatient's comfort. The sensitivity of the optodes, too, was improved by incorporating better refined techniques for manufacturing the fiber optic brushes and fixing the same to the optode transmitting and receiving windows. The modified and improved optodes, in the single as well as in the multiplexed modes, were subjected to various tests on different areas of the brain to determine their efficiency and functionality.

Estudo do comportamento parental face à criança com paralisia cerebral

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

Necessidades de formação/informação de cuidadores informais de indivíduos com sequelas de acidente vascular cerebral: proposta de um programa de formação

Este trabalho propõe-se identificar as necessidades de formação e informação dos cuidadores informais de indivíduos com sequelas de Acidente Vascular Cerebral (AVC) de forma a projetar uma proposta de formação que colmate essas mesmas necessidades. A investigação incide sobre uma área ainda pouco explorada a nível nacional e de grande relevância face ao envelhecimento populacional e suas consequências. Constata-se a insuficiência de informação/formação nesta área, pelo que se reforça a necessidade de preencher as lacunas de (in)formação daqueles que estão na primeira linha de prestação de cuidados ao idoso com sequelas de AVC. A dificuldade de encontrar uma formação para este público-alvo deve-se ao escasso conhecimento das suas reais necessidades, bem como, pelo facto de não ser dirigido a estas necessidades um plano formal e sistemático. A oferta de (in)formação assume-se como um pilar decisivo para dotar o cuidador informal de competências que salvaguardem o bem-estar da pessoa cuidada, assim como o seu próprio. No enquadramento teórico, houve a necessidade de contextualizar esta problemática abordando-se o AVC e suas sequelas, as idiossincrasias da educação de adultos cuidadores, bem como uma contextualização aprofundada das necessidades dos cuidadores informais. O reconhecimento do papel da família no ato de cuidar, e um apontamento acerca do cuidador informal são fatores determinantes neste processo. Para a identificação das necessidades foi conduzido um inquérito por entrevista semi-estruturada ao público-alvo, os cuidadores informais, bem como a informadores-chave (cuidadores formais e indivíduos com sequelas de AVC), efetuando-se uma subsequente análise de conteúdo. Verificou-se a importância da informação/formação neste processo do ato de cuidar em diferentes dimensões. Os dados obtidos permitiram o desenvolvimento de uma proposta de formação para cuidadores informais.

Efetividade de técnicas de fisioterapia no equilíbrio em pacientes com Acidente Vascular Cerebral

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia

Flujo sanguíneo cerebral durante el ejercicio de esprint

Se desconocen los efectos del entrenamiento interválico de alta intesidad (HIIT) sobre el flujo sanguíneo cerebral (FSC) y la oxigenación cerebral. Por ello reclutamos a 20 voluntarios que realizaron una sesión de HIIT (4 test de Wingate con recuperaciones de 4 minutos). Se midió la oxigenación del lóbulo frontal (OLF) y el Vastus lateralis (VL) a través de espectrofotometría cercana a los infrarrojos (NIRS). También se registró la velocidad de la sangre en las arterias cerebrales medias (vACM) mediante Doppler. La vACM disminuyó entre un 5 y 10 % en el primer esprint. En los siguientes esprints se redujo aún más. La vACM descendió en cada esprint coincidiendo con la disminución de la presión tele-espiratoria de dióxido de carbono (PETCO2) y con valores superiores de ventilación pulmonar (VE). Al interrumpirse el pedaleo se redujo bruscamente la vACM. Sin embargo, la OLF se mantuvo estable en el primer esprint sólo reduciéndose ligeramente durante el segundo y tercer Wingate (el cuarto fue similar al tercero). Este estudio muestra que la vACM disminuye durante los ejercicios de esprint, posiblemente debido a la hipocapnia. La reducción de la vACM no ejerce efectos funcionales ni relevantes sobre la oxigenación cerebral, gracias al ajuste de la conductancia vascular a través de los mecanismos de autoregulación, sin que parezca afectar negativamente al rendimiento.