Acute Recovery Research Articles

Fructose co-ingestion to increase carbohydrate availability in athletes.

Carbohydrate availability is important to maximize endurance performance during prolonged bouts of moderate‐ to high‐intensity exercise as well as for acute post‐exercise recovery. The primary form of carbohydrates that are typically ingested during and after exercise are glucose (polymers). However, intestinal glucose absorption can be limited by the capacity of the intestinal glucose transport system (SGLT1). Intestinal fructose uptake is not regulated by the same transport system, as it largely depends on GLUT5 as opposed to SGLT1 transporters. Combining the intake of glucose plus fructose can further increase total exogenous carbohydrate availability and, as such, allow higher exogenous carbohydrate oxidation rates. Ingesting a mixture of both glucose and fructose can improve endurance exercise performance compared to equivalent amounts of glucose (polymers) only. Fructose co‐ingestion can also accelerate post‐exercise (liver) glycogen repletion rates, which may be relevant when rapid (<24 h) recovery is required. Furthermore, fructose co‐ingestion can lower gastrointestinal distress when relatively large amounts of carbohydrate (>1.2 g/kg/h) are ingested during post‐exercise recovery. In conclusion, combined ingestion of fructose with glucose may be preferred over the ingestion of glucose (polymers) only to help trained athletes maximize endurance performance during prolonged moderate‐ to high‐intensity exercise sessions and accelerate post‐exercise (liver) glycogen repletion.

Eye-acupuncture as adjuvant therapy for stroke: A bibliometric analysis of clinical studies

Abstract Background Eye-acupuncture (EA) is a fine-needle acupuncture therapy for systemic diseases. This bibliometric analysis aims to provide a comprehensive review of the characteristics of EA for ischemic or hemorrhagic apoplexy based on clinical studies. Methods A total of 195 clinical studies from six databases such as CNKI, VIP, Wanfang Data, SinoMed, PubMed and the Cochrane Library from inception to December 31, 2017 were included. Bibliometric information mainly including study type, participant characteristics, intervention and comparison details, and outcomes were extracted. Data was analyzed descriptively using SPSS® software to determine their distribution (range, interquartile range) and central tendency (median). Results The studies covered 108 RCTs, 36 controlled clinical trials, 45 case series and 6 case reports on EA for treatment of ischemic or hemorrhagic apoplexy, involved 15 466 stroke patients. EA was used at different stages of ischemic or hemorrhagic apoplexy: acute stage (n = 38), recovery (n = 32), sequela (n = 13) and unclear (n = 112). The most frequently used EA acupoints were in the upper-jiao and lower-jiao regions. The commonly used comparisons were EA alone versus traditional acupuncture, or EA plus traditional acupuncture versus traditional acupuncture. Neurological deficit scale, Modified Barthel Index, and activities of daily living were the most frequently used outcome measures. Conclusion EA as an adjuvant therapy is effective and safe in treating stroke at acute and recovery stages, but high-quality RCTs are lacking.

Disrupted sleep predicts next day agitation following moderate to severe brain injury

ABSTRACTObjective: Disrupted sleep is common during acute recovery from traumatic brain injury (TBI) and has been linked to daytime agitation. This study investigated the relationship among nighttime sleep efficiency (SE), total sleep time (TST), wakefulness after sleep onset (WASO), and number of wake bouts (NWB) as measured by actigraphy to observer ratings of agitation for patients with TBI who were undergoing inpatient rehabilitation.Methods: This is a retrospective, observational study of a convenience sample of 65 individuals admitted to TBI inpatient rehabilitation who were monitored with actigraphy and the Agitated Behaviour Scale (ABS) for the first 72 h. Each patient’s average SE, TST, WASO, and NWB for the 72-h period was calculated using actigraphy for the rest interval from 2100 to 0700. Daily ABS scores were obtained for each day following the nighttime sleep period.Results: Patients were not significantly different on age, gender, etiology of injury, days post-injury, rehabilitation length of stay, or severity of injury as measured by length of posttraumatic amnesia (PTA). SE and TST were significantly lower for patients with agitation than for patients without agitation.Conclusions: This study suggests a relationship between disrupted sleep and agitation for patients with TBI who are undergoing inpatient rehabilitation.

Response of the Chinese Soft-Shelled Turtle to Acute Heat Stress: Insights From the Systematic Antioxidant Defense.

Understanding the responses of animals to acute heat stress can help to reveal and predict the effect of more frequent extreme hot weather episodes on animal populations and ecosystems in the content of global climate change. Antioxidant defenses can help to protect animals against oxidative stress caused by intense temperature variation. In the present study, systematic antioxidant responses to acute heat stress (Δ15°C and maintained for 12 h) and subsequent recovery were assessed by evaluating gene transcript levels and relative enzyme activities in tissues of Pelodiscus sinensis, a subtropical freshwater turtle. Targets included nuclear factor erythroid 2-related factor 2 (Nrf2, the upstream transcription factor), antioxidant enzymes, and the glutathione (GSH) and ascorbic acid (AA) systems. Results showed three main patterns of expression change among antioxidant genes: (1) gene expression of Mn-superoxide dismutase (Mn-SOD), glutathione peroxidase 4 (GPx 4), and catalase (CAT) increased in response to heat stress or recovery in the liver; (2) transcripts of most genes did not change in brain, liver, and kidney of P. sinensis; and (3) expression of several GST isoforms were affected by heat stress or recovery in brain and kidney. However, relative enzyme activities involved in antioxidant defense were little affected by acute heat stress and recovery, indicating a relatively conservative antioxidant response in P. sinensis. Furthermore, results for malondialdehyde (MDA) levels indicated that acute heat stress and recovery did not cause a net increase in oxidative damage in turtle tissues and, in particular, MDA levels in spleen decreased along with increased splenic ascorbic acid concentration. Overall, the present study revealed a conservative antioxidant response in P. sinensis, which may be indicative of a high basal stress tolerance and relate with adaptation to climate change in freshwater turtles.

Utilization patterns and clinical outcomes of rasburicase administration according to tumor risk stratification.

Current guidelines for tumor lysis syndrome management recommend rasburicase for high-risk patients. Adherence to guidelines has not been well studied, and the correlation between uric acid reduction and clinically relevant outcomes, such as acute kidney injury, remains unclear. Our study aims to describe rasburicase utilization patterns and outcomes in cancer patients with varying risks for tumor lysis syndrome. In this retrospective cohort study, we included cancer inpatients who received rasburicase for tumor lysis syndrome management at two affiliated academic hospitals from 2009 to 2015. Patients were classified by tumor lysis syndrome risk categories prior to drug administration. Primary outcomes included acute kidney injury incidence and renal recovery. Secondary outcomes included uric acid nadir, mortality, and hospital length-of-stay. Among 164 patients, 42 (26%) had high-, 63 (38%) had intermediate-, and 59 (36%) had low-risk for tumor lysis syndrome. A total of 94 patients (57%) had existing renal dysfunction prior to rasburicase use. This occurred more frequently in low- (68%) compared to intermediate- (57%) and high- (43%) risk patients (p = 0.044). A greater proportion of patients in the high-risk group (78%) had renal recovery when compared to the intermediate- (61%) or low- (45%) risk groups (p = 0.056). Despite a similar length of stay, the high-risk group had a significantly lower 30-day mortality (10%) when compared to intermediate- (25%) or low- (32%) risk groups (p = 0.029). Our results suggest that rasburicase may be frequently prescribed to treat hyperuricemia unrelated to tumor lysis syndrome in cancer patients. Improved education and adherence to guidelines may improve clinical and economic outcomes associated with rasburicase administration.

ESTSS2019 Rotterdam abstract book of keynotes, panels, and other invited program elements

Paper in a Day grew out of a wish to foster collaborations between young researchers from around the world. Many of these researchers will be future leaders in the domain of posttraumatic mental health and the field will benefit from their partnerships and teamwork. Paper in a Day is designed to stimulate international connections and the exchange of ideas by working on a tangible outcome: a brief paper or commentary for a peer-reviewed journal. This will be an intensive, productive and enjoyable day. Previous editions have led to conference contributions, journal articles, and lasting contacts (see article in Traumatic StressPoints). Because Paper in a Day will take place prior to the ESTSS conference, participants will have the opportunity to continue dialogue with colleagues during the rest of the conference. This year, Paper in a Day will make use of a unique research resource in the traumatic stress field – the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive. Learn more about PACT/R resources and data at www.childtraumadata.org. This international data archive of child trauma studies currently includes datasets from 32 studies, representing data from more than 5500 children exposed to a single incident trauma, e.g., injury, disaster, interpersonal violence. In addition to original study data/variables, PACT/R includes a growing set of harmonized variables that can facilitate cross-study analyses. Throughout the Paper in a Day process, leaders of the PACT/R Archive will be available to participants to answer questions and to approve data requests once research topics/questions are identified. After registration, participants will choose a topic based on shared interests and availability of relevant PACT/R data. In the weeks prior to the workshop, participants will individually prepare (e.g. read relevant articles, draft sections of the paper). The workshop will include plenary discussions about the topic and the drafted texts, and writing time in subgroups. Following the workshop, the draft will be finalized for submission.

Microglial-targeting induced by intranasal linalool during neurological protection postischemia

Stroke is the second cause of death and first cause of physical disability around the world; it affects the brain parenchyma through oxygen deficiency and spreads excitotoxicity. The complexity of the disease has made it difficult to find effective therapies. It is necessary to identify new treatments that effectively act within the narrow therapeutic window but also offer long-term protection poststroke. Our previous work found that oral linalool reversed the hippocampal and peripheral pro-inflammatory phospholipidomic biomarkers in ischemic rats; based on these observations, the “proof of concept” was to demonstrate that intranasal administration of linalool has a faster delivery to the central nervous system to protect it after focal ischemia in Wistar rats. The ischemic animals treated with linalool (25 mg/kg) showed a decrease in infarct volume at 24 h and seven days, and the treated animals had better neurological and motor skills at both poststroke times. Additionally, one month after daily intranasal administration of linalool, the ischemic rats showed improved relearning performance in the Morris water maze test. They also exhibited a reduction in microgliosis and decreased COX2, IL-1Beta and Nrf2 markers in the cerebral cortex and hippocampus. In astrocyte and microglial cultures, linalool reduced pro-inflammation and had a potent effect on microglial cells, generating Nrf2 subcellular redistribution under glutamate excitotoxicity conditions. Together, our findings indicate an acute and chronic recovery after ischemia induced by a daily intranasal puff of linalool, which mainly acts on microglial populations with anti-inflammatory actions.

Corrie Health Digital Platform for Self-Management in Secondary Prevention After Acute Myocardial Infarction.

Unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health interventions could be an effective tool in promoting self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction. A digital health intervention developed at Johns Hopkins-the Corrie Health Digital Platform (Corrie)-includes the first cardiology Apple CareKit smartphone application, which is paired with an Apple Watch and iHealth Bluetooth-enabled blood pressure cuff. Corrie targets: (1) self-management of cardiac medications, (2) self-tracking of vital signs, (3) education about cardiovascular disease through articles and animated videos, and (4) care coordination that includes outpatient follow-up appointments. The 3 phases of the MiCORE study (Myocardial infarction, Combined-device, Recovery Enhancement) include (1) the development of Corrie, (2) a pilot study to assess the usability and feasibility of Corrie, and (3) a prospective research study to primarily compare time to first readmission within 30 days postdischarge among patients with Corrie to patients in the historical standard of care comparison group. In Phase 2, the feasibility of deploying Corrie in an acute care setting was established among a sample of 60 patients with acute myocardial infarction. Phase 3 is ongoing and patients from 4 hospitals are being enrolled as early as possible during their hospital stay if they are 18 years or older, admitted with acute myocardial infarction (ST-segment-elevation myocardial infarction or type I non-ST-segment-elevation myocardial infarction), and own a smartphone. Patients are either being enrolled with their own personal devices or they are provided an iPhone and/or Apple Watch for the duration of the study. Phase 3 started in October 2017 and we aim to recruit 140 participants. This article will provide an in-depth understanding of the feasibility associated with implementing a digital health intervention in an acute care setting and the potential of Corrie as a self-management tool for acute myocardial infarction recovery.

Reduced heart rate variability and lower cerebral blood flow associated with poor cognition during recovery following concussion.

Although physiological deficits such as altered cerebral blood flow (CBF), and autonomic nervous system (ANS) dysregulation have been reported following a concussion, the relationship between CBF and ANS with functional outcome post-injury remains unclear. Our present study was designed to examine heart-rate variability (HRV) using percentage of successive NN intervals (pNN50) and CBF on day-3 (T1), day-21 (T2), and day-90 (T3) following a concussion in collegiate athletes (N = 31) in comparison to non-injured controls (N = 31). Continuous RR-interval (3-lead electrocardiogram), middle cerebral artery blood velocity (MCAV; transcranial Doppler ultrasonography), mean arterial pressure (MAP; finger photoplethysmography) were obtained at rest. Cerebrovascular conductance index (CVCi) was estimated as a ratio of MCAV to MAP. Cognition was evaluated with standard assessment of concussion (SAC), and Trails A & B. Compared to the controls, lower HRV (43 ± 15 vs. 27 ± 20%; p < 0.0001) was observed at T1 with normalization at T2 and T3. No difference in MCAV between the control and the concussed groups across the three time points were observed. However, post-hoc analyses indicated a positive relationship between MCAV at T1 phase with HRV and CVCi during T2, and T3 phases. Higher MCAV at T1 was also associated with better cognition scores during the asymptomatic T2 phase in the concussed athletes. Therefore, our results indicate ANS dysregulation during the acute recovery phase after a concussion. Differences in CBF may be one of the underlying causes behind heterogeneity in clinical symptoms and functional outcomes after a concussion and future studies are warranted to validate this finding.

Th2-TRMs Maintain Life-Long Allergic Memory in Experimental Asthma in Mice.

Allergic asthma is a chronic inflammatory remitting-relapsing disease affecting the airways. Long-lived allergen-specific memory CD4+ T helper 2 (Th2) cells in mice persist in lungs for more than 2 years after the induction of experimental allergic asthma (EAA). To further understand lung Th2 memory cells, we tracked CD4+ T cells in spleen and lungs from healthy mice, through the initiation of acute EAA, recovery (remission), and allergen-induced disease relapse. We identified a lung CD3+CD4+ cell subset that expresses CD44hiCD62L−CD69+ST2+, produces Th2 cytokines, and mediates allergen-induced disease relapse despite treatment with FTY720 and anti-CD4 antibody. These cells reside in the lung tissue for the lifetime of mice (>665 days) and represent long-lived pathogenic Th2 tissue resident memory cells (TRMs) that maintain “allergic memory” in lung. We speculate that these data implicate that human Th2-TRMs sentinels in lungs of patients are poised to rapidly respond to inhaled allergen and induce asthma attacks and that therapeutic approaches targeting these cells may provide relief to patients with allergic asthma.

Acute motor recovery in an acute flaccid paralysis cohort of Canadian children in 2018 (S1.005)

Acute motor recovery in an acute flaccid paralysis cohort of Canadian children in 2018 (S1.005)

Alterations of The Stem-Like Properties in The Breast Cancer Cell Line MDA-MB-231 Induced by Single Pulsed Doxorubicin Treatment

Abstract Development of chemoresistance remains a significant limitation for the treatment of cancer and contributes to recurrence of the disease. Both intrinsic and acquired mechanisms of chemoresistance are characteristics of cancer stem cells (CSCs) or stem-like cells (SLCs). The aim of the study was to assess the stem-like properties in the breast cancer cell line MDA-MB-231 during and after pulsed treatment with doxorubicin (DOX) in comparison to the untreated controls.The experimental cultures were exposed to therapeutic concentration of DOX for 48 hours (treatment cultures), and subcultured to post-treatment cultures 24 hours after the removal of DOX. Stem-like properties of the cellular populations in the treatment and post--treatment cultures were assessed by the expression of the stem-cell marker genes (CD24, CD44, ITGA6, ITGB1, POU5F1, NANOG, ALDH1A1), colony-formation efficiency, growth rates, and sensitivity to DOX, 5-fluorouracil (5FU), cisplatin (CIS), and vinblastine (VBL). Exposure to DOX induced formation of giant polyploid cells that persisted in the post-treatment culture. The recovery period was characterised by a decrease in the proliferation rate, viability, and cellular adherence. The post-treatment cultures displayed decreased sensitivity to DOX and increased sensitivities to 5FU, CIS, and VBL. Cells treated with DOX displayed increased expression levels of CD24, CD44, and ALDH1A, while their expression levels at least partially normalised in the post-treatment culture. The post-treatment cultures demonstrated significantly increased colony-formation ability. During treatment with sub-lethal levels of doxorubicin and during the acute recovery period, the survival mechanisms in the breast cancer cell line MDA-MB-231 may be mediated by formation of the cellular population with stem-like properties.

Remembering the pain of surgery 1 year later: a longitudinal examination of anxiety in children's pain memory development

Children who develop greater negatively-biased recall of pain (ie, recalled pain is higher than the initial pain report) following surgery are at risk for developing chronic pain; therefore, identifying risk factors for the development of biased pain memories is important. Higher anxiety has been implicated in the development of greater negatively-biased recall of pain; however, studies have not examined anxiety at multiple time points before and after a surgery and its relationship to children's postsurgical pain memories after 1 year. This prospective study examined a cohort of 237 children and adolescents undergoing major surgery. Anxiety sensitivity, pain catastrophizing, and pain anxiety were assessed at baseline, 48 to 72 hours after surgery, and at 6- and 12-month follow-ups. Pain intensity at rest, movement-evoked pain intensity, and pain unpleasantness were assessed daily in hospital. Memories for pain were elicited via telephone 1-year post surgery. Findings revealed that children who had higher levels of anxiety at baseline and 48 to 72 hours after surgery developed greater negatively-biased recall of pain intensity 12 months after surgery. Specifically, higher anxiety sensitivity at baseline and greater tendencies to catastrophize about pain at baseline and in the immediate acute recovery phase were most strongly linked to greater negatively-biased recall of pain. Greater negatively-biased recall of pain was related to higher pain intensity at 6 and 12 months post surgery. Findings support conceptual models of anxiety and pain memory biases and can inform intervention efforts to reduce anxiety in the pre- and post-op periods to minimize negative biases in pain memories.

Continuously monitoring shoulder motion after total shoulder arthroplasty: maximum elevation and time spent above 90° of elevation are critical metrics to monitor

Traditional clinical shoulder range-of-motion (ROM) measurement methods (ie, goniometry) have limitations assessing ROM in total shoulder arthroplasty (TSA) patients. Inertial measurement units (IMUs) are superior; however, further work is needed using IMUs to longitudinally assess shoulder ROM before TSA and throughout post-TSA rehabilitation. Accordingly, the study aims were to prospectively capture shoulder elevation in TSA patients and to compare the results with healthy controls. We hypothesized that patients would have reduced maximum elevation before TSA compared with controls but would have improved ROM after TSA. A validated IMU-based shoulder elevation quantification method was used to continuously monitor10 healthy individuals (4 men and 6 women; mean age, 69 ± 20 years) without shoulder pathology and 10 TSA patients (6 men and 4 women; mean age, 70 ± 8 years). Controls wore IMUs for 1 week. Patients wore IMUs for 1 week before TSA, for 6 weeks at 3 months after TSA, and for 1 week at 1 year after TSA. Shoulder elevation was calculated continuously, broken into 5° angle "bins" (0°-5°, 5°-10°, and so on), and converted to percentages. The main outcome measures were binned movement percentage, maximum elevation, and average elevation. Patient-reported outcome measures and goniometric ROM were also captured. No demographic differences were noted between the cohorts. Average elevation was not different between the cohorts at any time. Control maximum elevation was greater than pre-TSA and post-TSA week 1 and week 2 values. Time under 30° and time above 90° were equal between the cohorts before TSA. After TSA, patients showed decreased time under 30° and increased time above 90°. This study demonstrates that acute and chronic recovery after TSA can be assessed via maximum elevation and time above 90°, respectively. These results inform how healthy individuals and patients use their shoulders before and after TSA.

Normobaric hyperoxia ameliorates renal ischemia reperfusion injury in rats

IntroductionAcute kidney injury (AKI) represents an ever‐increasing clinical problem with high morbidity and mortality. The kidney, due to its inhomogeneous blood flow, is particularly susceptible to changes in oxygen delivery. Renal hypoxia constitutes a common hallmark of AKI, and in the progression to chronic kidney disease (CKD). However, the role of hypoxia per se in the acute phase of renal injury remains largely unclear. The present study investigated 1) the role of systemic hypoxia in the acute progression and recovery of AKI, and 2) if normobaric global hyperoxia following AKI improves renal outcome.MethodsAnaesthetized (thiobutabarbital 120mg/kg i.p.) adult male Sprague‐Dawley rats were subjected to unilateral complete warm renal ischemia for 45 minutes followed by 2 hours of reperfusion under normoxic (21% inspired oxygen, n=10), hypoxic (10% inspired oxygen, n=10), and hyperoxic (60% inspired oxygen n=10) conditions. Kidney function, renal hemodynamics, intrarenal tissue oxygen tension (PO2), and renal oxygen consumption were estimated before and after the ischemic insult.ResultsAll investigated parameters were similar between groups at baseline. Animals subjected to 10% inspired oxygen developed intrarenal tissue hypoxia, whereas animals subjected to 60% inspired oxygen presented with increased intrarenal PO2 demonstrating that the approach to manipulate intrarenal tissue oxygen availability was successful. Furthermore, GFR at baseline were independent of renal tissue oxygenation.IR per se caused a steep decline in GFR in all groups (−97 ± 1, −87 ± 3, and −70 ± 11% for hypoxic, normoxic and hyperoxic animals, respectively), although renal blood flow and renal vascular resistance were similar before and after the ischemic insult. However, following IR there was a linear relationship between GFR and cortical PO2 when analysing all animals in all groups (Fig 1, linear regression P&lt;0.05).ConclusionThis study demonstrates that renal function following IR is dependent on intrarenal oxygen availability. Furthermore, normobaric hyperoxia‐treatment initiated at the time of the ischemic insult has the potential to protect kidney function.Support or Funding InformationThis study was supported by the Swedish Research Council Medicine and Health.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Dismantling airway disease with the use of new pulmonary function indices.

We are currently limited in our abilities to diagnose, monitor disease status and manage chronic airway disease like asthma and chronic obstructive pulmonary disease (COPD). Conventional lung function measures often poorly reflect patient symptoms or are insensitive to changes, particularly in the small airways where disease may originate or manifest. Novel pulmonary function tests are becoming available which help us better characterise and understand chronic airway disease, and their translation and adoption from the research arena would potentially enable individualised patient care.In this article, we aim to describe two emerging lung function tests yielding novel pulmonary function indices, the forced oscillation technique (FOT) and multiple breath nitrogen washout (MBNW). With a particular focus on asthma and COPD, this article demonstrates how chronic airway disease mechanisms have been dismantled with the use of the FOT and MBNW. We describe their ability to assess detailed pulmonary mechanics for diagnostic and management purposes including response to bronchodilation and other treatments, relationship with symptoms, evaluation of acute exacerbations and recovery, and telemonitoring. The current limitations of both tests, as well as open questions/directions for further research, are also discussed.

Regional Catheters for Outpatient Surgery-a Comprehensive Review.

This review summarizes and discusses the history of continuous catheter blockade (CCB), its current applications, clinical considerations, economic benefits, potential complications, patient education, and best practice techniques. Regional catheters for outpatient surgery have greatly impacted acute post-operative pain management and recovery. Prior to development, options for acute pain management were limited to the use of opioid pain medications, NSAIDS, neuropathic agents, and the like as local anesthetic duration of action is limited to 4-8h. Moreover, delivery of opioids post-operatively has been associated with respiratory and central nervous depression, development of opioid use disorder, and many other potential adverse effects. CCB allows for faster recovery time, decreased rates of opioid abuse, and better pain control in patients post-operatively. Outpatient surgical settings continue to focus on efficiency, quality, and safety, including strategies to prevent post-operative nausea, vomiting, and pain. Regional catheters are a valuable tool and help achieve all of the well-established endpoints of enhanced recovery after surgery (ERAS). CCB is growing in popularity with wide indications for a variety of surgeries, and has demonstrated improved patient satisfaction, outcomes, and reductions in many unwanted adverse effects in the outpatient setting.

Bio-Psychosocial Needs for Patients with Second Degree Burns: Suggested Rehabilitation Program and Follow up Care

Burn injuries are considered, worldwide, one of the leading causes of injury, morbidity and mortality. Second-degree burns may affect patients: physically, socially and psychologically. The aim of the study is to identify the physical, social, and psychological needs of patients with second degree burns to suggest are habilitation program and follow up care that will improve quality of life after acute stage recovery. To achieve the aima descriptive research was undertaken. The study was conducted at the outpatient clinic of a burn unit, affiliated to a University hospital, in Cairo, Egypt. A convenience sample of 154 patients with second degree burns from both genders and aged 18 years old or above were the subjects of the study. Five tools were adopted for data collection: 1) An interview sheet, 2) Brief burn specific health scale (BSHS-B), 3)Self-esteem scale, 4) Body image and appearance scale, and 5) Social needs assessment. The results revealed that patients with second degree burns need physical, social, and psychological support to pass through the life-threatening experience. There is a highly statistically significant relation among bio-psychosocial needs for patents with second degree burn. Second degree burns affect patients' physical, psychological, and social well-being and preparation is needed to achieve a healthy recovery. The study recommends the implementation of a health awareness program to overcome the incidence of problems due to burns that might have a serious impact on the quality of life. A targeted rehabilitation program will enhance physical, psychological, and social adaptation as well as a healthy re-integration to the society.

Agitated behavior scale in pediatric traumatic brain injury

ABSTRACTAgitation following TBI commonly occurs during the acute recovery phase. The ABS is a valid measure of agitation in adults following TBI. The objective of the study was to determine if ABS scores accurately measure acute agitation in pediatric patients recovering from TBI. The ABS was completed twice daily for 4 days and mean ABS scores were calculated. Physicians assessed patients’ agitation daily using a VAS. In addition, interventions for agitation were recorded. The association between ABS and VAS scores was assessed using Spearman’s correlation. The relationship between the number of medication classes taken for agitation (0, 1–2, or ≥3) and ABS scores was assessed using one-way analysis of variance. Finally, the association between the use of hand restraints and ABS scores was examined using an unpaired two-sample t-test. Twenty-six pediatric patients with acute TBI were included. ABS scores significantly associated with VAS scores. Patients that required interventions for agitation (hand restraints or ≥3 medication classes) had higher ABS scores than patients that did not receive any intervention. The study supports the use of ABS scoring to measure agitation in pediatric patients with TBI. However, additional studies are warranted to further support the validity of this scale.Abbreviations: TBI: Traumatic brain injury; ABS: Agitated Behaviour Scale; VAS: visual analog scale; PCCU: Pediatric Critical Care Unit

Effectiveness of Grounded Sleeping on Recovery After Intensive Eccentric Muscle Loading.

Purpose: We set out to investigate the effectiveness of grounded sleeping on the time course of recovery with respect to muscle soreness and athletic performance after intensive eccentric muscle loading.Methods: Twenty-two healthy participants were recruited for this study and randomly assigned to an experimental group (GRD, grounded sleeping, n = 12) or control group (UGD, sham-grounded sleeping, n = 10) to evaluate the effects of 10 days recovery with GRD vs. UGD following a single intensive downhill treadmill intervention in a triple-blinded (participant, tester, and data analyst) manner. To operationalize recovery a test battery was performed at baseline and on days 1, 2, 3, 5, 7, and 10 post-intervention: (1) perception of muscle soreness (VAS), (2) creatine kinase blood levels (CK), (3) maximum voluntary isometric contraction (MVIC) for both legs, (4) counter movement jump (CMJ) and drop jump (DJ) performance. Furthermore, in four participants blood was sampled for detailed analysis of complete blood counts and serum-derived inflammation markers.Results: The downhill treadmill running intervention led to distinct changes in all measured parameters related to fatigue. These changes were detectable already 5-min post intervention and were not fully recovered 10 days post intervention. GRD led to less pronounced decrease in performance (CMJ, MVIC) and less increase with respect to CK compared with UGD (all P < 0.05). Detailed blood samples demonstrated that grounded sleeping modulates the recovery process by (a) keeping a constant hemoconcentration, as represented by the number of erythrocytes, and the hemoglobin/hematocrit values; and (b) by the reduction of muscle damage-associated inflammation markers such as, IP-10, MIP-1α, and sP-Selectin.Conclusion: The downhill running protocol is a feasible methodology to produce long term muscle soreness and muscular fatigue. GRD was shown to result in faster recovery and/or less pronounced markers of muscle damage and inflammation. GRD might be seen as a simple methodology to enhance acute and long-term recovery after intensive eccentric exercises.