Case Series Approach Research Articles

Neural Correlates of Food Cue Exposure Intervention for Obesity: A Case-Series Approach.

BackgroundPeople with overweight have stronger reactivity (e.g., subjective craving) to food cues than lean people, and this reactivity is positively associated with food intake. Cue reactivity is a learned response that can be reduced with food cue exposure therapy.ObjectivesIt was hypothesized that participants after food cue exposure therapy would show reduced neural activity in brain regions related to food cue reactivity and increased neural activity in brain regions related to inhibitory-control as compared to participants receiving a control lifestyle intervention.MethodNeural activity of 10 women with overweight (BMI ≥ 27 kg/m2) in response to individually tailored visually presented palatable high-caloric food stimuli was examined before vs. after a cue exposure intervention (n = 5) or a control lifestyle (n = 5) intervention. Data were analyzed case-by-case.ResultsNeural responses to food stimuli were reduced in food-cue-reactivity-related brain regions after the lifestyle intervention in most participants, and generally not after the cue exposure therapy. Moreover, cue exposure did not lead to increased activity in inhibitory-control-related brain regions. However, decreased neural activity after cue exposure was found in most participants in the lateral occipital complex (LOC), which suggests a decreased visual salience of high-caloric food stimuli.ConclusionReceiving a cue exposure therapy did not lead to expected neural responses. As cue exposure relies on inhibitory learning mechanisms, differences in contexts (e.g., environments and food types) between the intervention setting and the scanning sessions may explain the general lack of effect of cue-exposure on neural activity.

AN EXPLORATORY CASE SERIES ANALYSIS OF THE USE OF PRIMAL REFLEX RELEASE TECHNIQUE™ TO IMPROVE SIGNS AND SYMPTOMS OF HAMSTRING STRAIN

Hamstring strain (HS), a common condition found among the injured physically active population, is often treated with rest, stretching, and modalities. Primal Reflex Release Technique™ (PRRT™) is a manual therapy technique used to treat pain caused by over-stimulation of the body's primal reflexes. The purpose of this case series was to explore the immediate effects of PRRT™ for treating hamstring strains. A multi-site case series approach was used to report on the treatment of six patients with HS using PRRT™. The Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS) and range of motion (ROM) measurements were collected, as well as evaluation of symmetry of the sacroiliac joints, reported as sacroiliac dysfunction(SJD). Primal Reflex Release Technique™ (PRRT™) was an effective treatment for subjects with HS. Subjects reported a significant decrease in pain on the NPRS, averaging five points over the course of the treatment (95% CI of 3.374, 6.626). Functional measures on the PSFS were significantly improved following treatment (post-treatment mean = 7.8 ± 1.84, pre-treatment mean = 4.8 ± .97, p < .001; CI: -2.1, -3.9). The mean change on the Passive Knee Extension Test (PKE) (mean = 8.20 ° ± 3.96 °) and ASLR (mean = 10.333 ° ± 8.98 °) indicated statistically significant improvements of post-treatment ROM (mean change = 8.20 ° ± 3.96 °, p = .01). The presence of SJD was observed in all subjects prior to treatment and resolved in all subjects when reassessed after treatment. In this case series, the use of PRRT™ resulted in decreased pain, increased function, and increased range of motion, as well as resolved SJD. The Primal Reflex Release Technique™ may be useful in decreasing symptoms of HS acutely, but long-term effects are unknown at this time. Clinicians should consider using a treatment which targets the autonomic nervous system when addressing pain associated with HS. Level 4 - case series.

Characteristics of Lung Cancer Patients in Haji Adam Malik General Hospital Medan in 2016-2018

Lung cancer is a malignant disease in the lung where abnormalities caused by collection of genetic changes in the epithelial cells of the airway, which lead to cell proliferation that cannot be controlled. This study was conducted to determine the characteristics of lung cancer patients in Haji Adam Malik General Hospital Medan in 2016-2018. This research is a descriptive study with a case series approach. The study population was 311 lung cancer patients using Total Sampling method. The tendency of inpatient lung cancer patients visiting H. Adam Malik General Hospital Medan in 2016-2018 has decreased. The highest proportion of patients with lung cancer based on sociodemography obtained 65-69 years old age group, men with 3: 1 sex ratio, work of farmers, living outside the city of Medan, the main complaint was more than one complaint, had a history of smoking, no pleural effusion occurred, the type of adenocarcinoma histology and the method of taking a cytological fluid specimen. There was a statistically significant relationship between age with sex, sex with occupation, sex with smoking history, occupation with primary complaints, occupation with smoking history, and histology type by specimen collection and there rest have no statistically significant difference.

Exploring the Viability of NARNIA with Cognitive-Communication Difficulties: A Pilot Study.

Everyday discourse is a common context for the difficulties experienced by people with acquired neurogenic communication disorders. While evidence is present for effective manualized interventions that directly improve the discourse skills in aphasia, this remains limited for people with cognitive-communication disorders. This proof of concept study used an in-depth case series approach to trial the NARNIA discourse intervention used successfully in aphasia to explore transferability of the protocol and effectiveness in people with cognitive-communication impairments. Four female participants with mild to moderate cognitive-communication difficulties (mean age: 52.8 years)-two following traumatic brain injury and two following vascular episodes-were recruited. Modifications were made to the protocol to accommodate the participant group. Cognitive-linguistic abilities, self-perceptions of communicative behavior and psychosocial recovery, and repeated discourse measures were assessed pre-, immediately post, and at 4 weeks following intervention, to measure treatment effectiveness. Significant gains were observed in quantity of output, informativeness, and efficiency of information across both everyday and narrative discourse genres for all participants. However, in contrast to previous studies, minimal change was observed in discourse macrostructure elements. Significant improvements were also observed in memory or working memory for two participants. This study provides preliminary evidence for the effectiveness of using an adapted protocol with people with cognitive-communication disorders, highlighting how adaptations may address the cognitive needs of this diverse clinical group.

Adapting the Social-Ecological Framework for Chronic Pain Management and Successful Opioid Tapering.

In 2015, Solano County's Medi-Cal insurer implemented a new policy to taper patients using high-dose opioids (≥120-mg morphine equivalent dose) to a safer level to follow best practices to address the opioid epidemic. To evaluate the effect of the 2015 Solano County Medi-Cal prescribing policy, gain insight into the patient experience of undergoing opioid tapering, and generate hypotheses for further study. Using a case series approach, researchers completed medical record reviews of affiliated clinical records, Solano County Vital Statistics, and California's prescription monitoring program in 2018. After exclusions, eligible patients were asked to participate in a comprehensive qualitative interview. Medical record reviews of 38 patients found the majority were not using opioids using them at a morphine equivalent dose of 90 mg or less. The reviews also found that mental illness and obesity prevalence were higher than Solano county baseline levels. Furthermore, naloxone was not prescribed to any of the 38 patients. Researchers reached 15 of the 38 patients by phone, and ultimately 6 completed the interview process. Themes and emergent concepts from interviews identified a lack of empathetic connection with health care professionals, poor understanding of overdose risks, persistent pain, and confirmed naloxone underuse. Safer prescribing policies may take multiple years to fully implement and need to be employed across the jurisdiction to minimize doctor-shopping and adverse effects on patients with chronic pain. Approaching pain management through the social-ecological model can address potential root causes of addiction and establish a framework for doctors to provide compassionate care, community leadership, and advocacy for these patients.

E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach

Since June, 2019, more than 1000 new cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported in the USA. Patients presented with dyspnoea, cough, and were found to be hypoxaemic with bilateral airspace opacities on chest imaging. Most patients required management in the intensive care unit and steroid therapy. All patients recovered with cessation of vaping, supportive care, and steroid therapy and remained symptom free at follow up. E-cigarette use continues to rapidly escalate in the USA, particularly among youth. Cases were defined as patients admitted to the University of Rochester Medical Center (Rochester, NY, USA) who had used e-cigarettes or another vaping device in the 30 days before presentation, and who had bilateral airspace opacification on chest imaging (CT or x-ray). Case details were obtained via medical record review and patient interviews over the past 3 months including symptomatology, physical exam data, imaging studies, laboratory data, vaping history, and subsequent outpatient follow-up data. In collaboration with the New York State Department of Health, our hospital developed a novel clinical practice algorithm based on statewide physician feedback along with input from experts in environmental health, medical toxicology, infectious disease, epidemiology, and chronic disease prevention. We report 12 cases treated for suspected EVALI at our medical centre between June 6, 2019, and Sept 15, 2019. Ten (83%) patients had dyspnoea, fever, and emesis and nine (75%) had cough. 11 (92%) patients reported the use of e-cigarette cartridges containing tetrahydrocannabinol oil. Although eight (67%) patients required admission to the intensive care unit for hypoxaemic respiratory failure, no deaths occurred. The median hospitalisation duration was 7 days (IQR 7-8). All patients completing follow up (6 [50%]) had resolution of previous chest CT findings and normal spirometry. The clinical algorithm focuses on the key signs and symptoms of EVALI and the importance of ruling out infection and other cardiopulmonary conditions before making a presumptive diagnosis of EVALI. Patients with suspected EVALI in our cohort had life-threatening hypoxaemia, with 67% requiring management in the intensive care unit. Despite the severity of presentation, similar to previous reports of patients with EVALI, most patients improved within 1-2 weeks of initial presentation after vaping cessation and administration of systemic corticosteroids when needed. Almost all (92%) patients with suspected EVALI reported vaping a THC product, making THC containing e-liquids or oils a key focus on the ongoing nationwide investigations into the cause of EVALI. Additional research is required to understand the potential toxins, underlying pathophysiological mechanisms, and identification of susceptible individuals at higher risk for hospitalisation due to EVALI. To our knowledge we present the first clinical practice algorithm for the evaluation and management of EVALI, which will be useful for both acute management and improved accurate reporting of this life-threatening respiratory illness. None.

Metallic air pollutants and breast cancer heterogeneity

BackgroundEmerging evidence suggests airborne metals may be associated with breast cancer risk. However, breast cancer is heterogenous and associations with heavy metals vary by subtype. Heavy metals possess both carcinogenic and xenoestrogenic properties which may be related to different tumor etiologies. Therefore, we tested for etiologic heterogeneity, using a case-series approach, to determine whether associations between residential airborne metal concentrations and breast cancer differed by tumor subtype. MethodsBetween 2005 and 2008, we enrolled incident breast cancer cases into the Breast Cancer Care in Chicago study. Tumor estrogen and progesterone receptors status was determined by medical record abstraction and confirmed immunohistochemically (N = 696; 147 ER/PR-negative). The 2002 USEPA's National Air Toxics Assessment census-tract estimates of metal concentrations (antimony, arsenic, beryllium, cadmium, chromium, cobalt, lead, manganese, mercury, nickel and selenium) were matched to participants' residences of the same year. Adjusted logistic regression models were used to examine whether the airborne heavy metal associations differed by tumor ER/PR status. Principal component analysis was performed to assess associations by metal co-exposures. ResultsComparing the highest and lowest quintiles, higher concentrations of antimony (odds ratio[OR]: 1.8, 95% confidence interval[CI]: 0.9, 3.7, P-trend: 0.05), cadmium (OR: 2.3, 95% CI: 1.2, 4.4, P-trend: 0.04) and cobalt (OR: 2.0, 95% CI: 0.9, 4.4, P-trend: 0.04) were associated with ER/PR-negative breast cancer. Mixture analysis using principal components suggested co-exposures to multiple airborne heavy metals may drive associations with tumor receptor status. ConclusionsAmong women diagnosed with breast cancer, metallic air pollutants were associated with increased odds of developing ER/PR-negative breast cancer.

Social Network Structure in Young Stroke Survivors with Aphasia: A Case Series Report

The aim of this study was to profile the social networks of young adult stroke survivors with aphasia. A case series approach using four persons with aphasia (PWA) younger than 50 years was utilized. Semistructured interviews were completed with the PWA and their primary caregiver/family to explore the most salient relationships in the PWA's social network. PWAs in this study exhibited very small social networks with the most salient relationships consisting of immediate family members. Mothers were the primary caregiver for the two most impaired PWA. Prestroke friendships were dissolved or reduced at the onset of aphasia. The most impaired PWAs spent most of their days in isolation without a consistent communication partner. This study suggests young adult stroke survivors with aphasia have significant changes in their social network structure after stroke, but it is unclear if the observed change in social network structure is more related to age or level of communication impairment.

Do facial first impressions reflect a shared social reality?

Influential facial impression models have repeatedly shown that trustworthiness, youthful-attractiveness, and dominance dimensions subserve a wide variety of first impressions formed from strangers' faces, suggestive of a shared social reality. However, these models are built from impressions aggregated across observers. Critically, recent work has now shown substantial inter-observer differences in facial impressions, raising the important question of whether these dimensional models based on aggregated group data are meaningful at the individual observer level. We addressed this question with a novel case series approach, using factor analyses of ratings of twelve different traits to build individual models of facial impressions for different observers. Strikingly, three dimensions of trustworthiness, youthful/attractiveness, and competence/dominance appeared across the majority of these individual observer models, demonstrating that the dimensional approach is indeed meaningful at the individual level. Nonetheless, we also found differences in the stability of the competence/dominance dimension across observers. Taken together, results suggest that individual differences in impressions arise in the context of a largely common structure that supports a shared social reality.

Abstract WP200: Deficits in Proprioception Associated With Supramarginal Gyrus Lesions After Stroke - A Case Series Approach

Proprioception is our sense of limb position and movement without vision. Impaired proprioception leads to difficulty performing activities of daily living. While proprioceptive deficits are common after stroke, the neural correlates underlying them are relatively unknown. Recent voxel based lesion analysis evidence suggests that a cluster of regions is implicated in these deficits, including the supramarginal gyrus (SMG) and S1. Using a case series approach, we assessed the impact of different lesion combinations on proprioception, encapsulating SMG with and without S1 and other brain regions in this network. Robotic assessments of proprioception (position matching and kinaesthesia) and MRI/CT scans were acquired for 217 individuals around 1-week post stroke. Across both robotic assessments, performance was compared to a normative model of healthy controls to detect the presence of proprioceptive deficits. Lesions on scans were marked by a trained assessor and then verified by a neurologist. Individuals with lesions to combinations of SMG, S1, insula and operculum were extracted. The extent of damage to each region was determined using the Automated Anatomical Labelling and Catani atlases. A total of 62 subjects with lesion combinations of interest were identified and analysed in more detail (13 SMG lesions). The extent of SMG damage was small, ranging from 0.03% to 25.95%. Position sense deficits were common for both right (6/6) and left SMG (6/7) lesions. Even in the absence of S1 lesions, these deficits remained prevalent. Deficits in kinaesthesia were more common in individuals with combined SMG and S1 lesions than in those without concurrent S1 lesions. Deficits in both proprioceptive assessments were uncommon in those with left S1 lesions in the absence of SMG lesions. Those with right S1 lesions displayed greater deficits than those with left S1 lesions. Results indicate that brain areas beyond S1 must be considered to better understand proprioceptive deficits and develop better strategies for improving proprioceptive function after stroke. The contributory influence of each area should be further explored in isolation.

Profile of Dengue High Fever in Blitar City at 2015-2017

Background: Dengue Hemorrhagic Fever (DHF) remains a health problem in Indonesia where the number of cases reported in 2015 was 129,650 cases with a total death toll of 1,071 people. The city of Blitar is the region with the 13th highest dengue fever case in East Java Province. Purpose: This study aims to describe cases of dengue fever in the city of Blitar. Methods: This study is an observational descriptive study with a case series approach. The data used in this study is dengue fever data in the East Java Health Profile for 2015-2017. Results: The majority of dengue fever occurred in the age group 5-14 years (46.72%). Most cases of dengue fever occur in men (51.19%). The city of Blitar is an area with cases of dengue fever which is high each year with the Incidence Rate (IR) in 2016 reaching 189 per 100,000 population. The increase in cases of dengue fever is not in line with the increase in rainfall in the city of Blitar. Jumantik has 166 people spread across 21 regions, but the free larvae (ABJ) from Blitar is still 79%, far from the success indicator of 95%. Conclusion: Blitar City is an endemic area of DHF that has stratification of 20 hamlets. The pattern of dengue fever in Blitar City in 2015-2017 was the highest in men and in the age group of 5-14 years.

Neutrophyl Lymphocyte Ratio in Tuberculosis Patients and Multi Drug Resistant Tuberculosis Patients

Background: Delayed in diagnosis and treatment of tuberculosis will increase the risk of MDR TB. WHO recommends Xpert MTB/RIF as&#x0D; diagnostic tools to identify MDR TB. Availability of Xpert MTB/RIF is still limited, another diagnostic tool is needed. Neutrophyl lymphocyte&#x0D; ratio (NLR) was presumed to be able to identify the probability of MDR TB. The aim of this study is to evaluate the comparison of NLR in tuberculosis&#x0D; and MDR TB patients.&#x0D; Methods: This is an analytic descriptive study with case series approach in Adam Malik General Hospital Medan. This study held since&#x0D; January – December 2015 with number of sample as much as 100 bacteriological confirmed TB patients and 100 MDR TB patients. We&#x0D; performed leukocyte differential count from peripheral blood examination to obtain NLR&#x0D; Result: Mean NLR of TB patient 4.62±2.37 and MDR TB 3.28±1.44. There was significant difference of NLR between both groups using&#x0D; Mann-Whitney test (P=0.001). The cut off value by ROC analysis was 2.91 with sensitivity, specificity, positive predictive value, negative&#x0D; predictive value and accuracy was 77%, 50%, 60.6%, 68.4% and 63.5% respectively.&#x0D; Conclusion: There was significant difference of NLR between bacteriological confirmed TB patients and MDR TB patients. Value of NLR

Exploring self-concept, wellbeing and distress in therapeutic songwriting participants following acquired brain injury: A case series analysis

ABSTRACTAcquired brain injury (ABI) presents a significant threat to sense of self and necessitates a complex process of psychosocial adjustment. Self-concept changes remain understudied in the early stages of inpatient rehabilitation. The aim of the current study was to examine changes in self-concept, distress, wellbeing and functional skills for five inpatients undertaking a music therapy intervention within a subacute rehabilitation centre in Victoria, Australia. Participants completed a six-week, 12-session therapeutic songwriting programme to produce past-, current- and future-self-focused songs. A range of self-concept, subjective wellbeing and distress measures were completed pre-, mid- and post-intervention. A descriptive case series approach was applied to determine trends in pre-post scores for five individual cases. Participants showing the greatest gains across self-concept and subjective wellbeing indices also showed the greatest functional gains on the Functional Independence Measure (FIM) from admission to discharge. The current study highlights the importance of examining early changes in self-concept, wellbeing and distress in subacute rehabilitation, and suggests that individualised songwriting programmes warrant further research attention in neurological populations.

An Acceptance and Commitment Therapy (ACT) intervention for Chronic Fatigue Syndrome (CFS): A case series approach

ObjectiveAcceptance and Commitment Therapy (ACT) has been shown to improve the psychological well-being of individuals suffering from a range of chronic health conditions, and aims to increase psychological flexibility in order to foster greater engagement in personally meaningful behavior. We aimed to assess whether the approach (delivered via guided bibliotherapy) may have utility for individuals experiencing the debilitating effects of Chronic Fatigue Syndrome (CFS). MethodsWe used a mixed-methods multiple single-case design to explore the effects of a six week self-help ACT intervention for six participants diagnosed with CFS. ResultsSignificant increases in ratings of valued living were replicated and maintained in four participants, with qualitative data further highlighting the importance of the values component of the intervention. Acceptance scores improved in four participants but were not maintained at follow-up, whereas improvements in psychological flexibility were observed and maintained for three participants. All participants wearing an activity monitor evinced increased physical activity postintervention, which was maintained at follow up in half of the participants. ConclusionThe ACT self-help intervention appeared to benefit most participants on at least one assessed metric, particularly in terms of the promotion and pursuit of individual values, and increased physical activity. However, the results suggest these benefits may be difficult to maintain longer term without further input.

Respiratory effect of beta-blockers in people with asthma and cardiovascular disease: population-based nested case control study

BackgroundCardiovascular disease (CVD) is a common comorbidity in people with asthma. However, safety concerns have caused heterogeneity in clinical guideline recommendations over the use of cardioselective beta-blockers in people with asthma and CVD, partly because risk in the general population has been poorly quantified. The aim of this study was to measure the risk of asthma exacerbations with beta-blockers prescribed to a general population with asthma and CVD.MethodsLinked data from the UK Clinical Practice Research Datalink was used to perform nested case-control studies among people with asthma and CVD matched on age, sex and calendar time. Adjusted incidence rate ratios (IRR) were calculated for the association between oral beta-blocker use and moderate asthma exacerbations (rescue oral steroids) or severe asthma exacerbations (hospitalisation or death) using conditional logistic regression.ResultsThe cohort consisted of 35,502 people identified with active asthma and CVD, of which 14.1% and 1.2% were prescribed cardioselective and non-selective beta-blockers, respectively, during follow-up. Cardioselective beta-blocker use was not associated with a significantly increased risk of moderate or severe asthma exacerbations. Consistent results were obtained following sensitivity analyses and a self-controlled case series approach. In contrast, non-selective beta-blockers were associated with a significantly increased risk of moderate asthma exacerbations when initiated at low to moderate doses (IRR 5.16, 95% CI 1.83–14.54, P = 0.002), and both moderate and severe exacerbations when prescribed chronically at high dose (IRR 2.68, 95% CI 1.08–6.64, P = 0.033 and IRR 12.11, 95% CI 1.02–144.11, P = 0.048, respectively).ConclusionsCardioselective beta-blockers prescribed to people with asthma and CVD were not associated with a significantly increased risk of moderate or severe asthma exacerbations and potentially could be used more widely when strongly indicated.

Separate Serial Order Short-term Memory Systems: A Case Series Approach

Separate Serial Order Short-term Memory Systems: A Case Series Approach

Ulnar impaction syndrome: A case series and imaging approach

Ulnar-sided wrist pain can be attributed to many pathological processes. This can include traumatic, inflammatory or degenerative conditions. Ulnar impaction syndrome is a group of syndromes that are degenerative conditions of the wrist caused by an abnormal joint configuration or due to abnormal use. This leads to an increase in axial loading across the ulnar side of the wrist with resultant joint degeneration. The structures in the wrist concerned in this syndrome are the triangular fibrocartilage complex, the distal radio-ulnar joint and the lunate triquetral bones at their ulnar articulations. Even though a number of modalities exist to image the wrist, the options for accurately assessing ulnar impaction syndrome are limited and may be challenging. Accurate assessment of the triangular fibro-cartilage complex is essential, as it lies central in the classification of the disease.

Cortical beta oscillations and motor thresholds differ across the spectrum of post-stroke motor impairment, a preliminary MEG and TMS study

BackgroundCortical oscillatory activity in the beta frequency band (13–30Hz) is associated with voluntary movement and may be altered in motor disorders such as stroke. MethodsWe used a multimodal case-series approach to investigate movement-related beta oscillations, cortical excitability and upper-limb motor-function in 10 chronic stroke-patients across a broad range of motor-impairment. Assessments included: (i) whole-head magnetoencephalography (MEG) during a voluntary motor task; (ii) resting and active motor-thresholds to transcranial magnetic stimulation (TMS); and (iii) assessments of upper-limb motor-function. ResultsMEG revealed distinct patterns of movement-related beta oscillations according to motor-function. An elongated event-related desynchronisation (ERD) was correlated with poorer motor-function (p=0.004) whereas an elongated event-related resynchronisation (ERS) was correlated with higher motor function and lower TMS motor thresholds on the more-affected side (p=0.014 and p<0.001, respectively). Oscillation amplitude and laterality were also correlated with motor-function, where a stronger ERD/ERS and a greater relative contribution from the ipsilesional hemisphere were correlated with better motor-function (p=0.016, p=0.025). Unlike TMS responses and motor-function, the temporal profile of beta oscillations was largely symmetrical for movements of the more- and less-affected hands. ConclusionsBeta ERD/ERS patterns differ across the post-stroke motor impairment spectrum, and are bilaterally similar after stroke. Both the amplitude and duration of beta oscillations relate to post-stroke motor-function. SignificanceThe contralesional hemisphere is not unaffected post-stroke. Caution is needed when generalising imaging and neurophysiological findings from patients with moderate to high motor ability to the more heterogeneous general stroke population and particularly those with low levels of residual voluntary motor-function.

Intussusception risk after RotaTeq vaccination: Evaluation from worldwide spontaneous reporting data using a self-controlled case series approach

The increased risk of intussusception after vaccination with the rhesus-human reassortant rotavirus vaccine Rotashield led to its withdrawal in 2005. We assess the risk of intussusception following the pentavalent rotavirus vaccine (RV5) on the basis of worldwide reports to the manufacturer up to May 2014, using a self-controlled case series. The method had to be modified to account for the under-reporting, a specific feature of pharmacovigilance spontaneous reports. The risk of intussusception occurring in either of the 0- to 2-day, 3- to 7-day or 8- to 14-day risk periods, was compared to the risk in the 15- to 30-day period. A total of 502 cases occurring 0–30 days after a vaccine dose were studied, including 188 cases after the first dose, 190 cases after the second dose, and 124 cases after the third dose. The incidence risk ratio relative to the control period was highest for the 3- to 7-day period and equal to 3.45 (95% CI 1.84–6.55), 1.63 (0.86–3.13) and 1.73 (0.86–3.51) after the first, second and third dose, respectively. Rotavirus vaccination with RV5 increases the risk of intussusception 3–7 days following vaccination, mainly after the first dose and marginally after the second and third doses. The risk is small and restricted to a short time window. It does not outweigh the benefit of the vaccination, but parents of vaccinated infants should be informed in order to react appropriately to the first symptoms. With appropriate assumptions about the reporting rate, spontaneous reports of adverse events after vaccination can be studied to evaluate vaccine safety.

The Influence of Dynamic Orthosis Training on Upper Extremity Function after Stroke: A Pilot Study

The goal of this study was to assess the use of a dynamic orthosis on upper extremity function in chronic stroke patients. A case series approach was utilized, with provision of a training program (3x/week, 50 minutes/session for 8 weeks) and employment of a dynamic orthosis. Six volunteers with persistent hemiparesis due to a single, unilateral stroke performed task-oriented movements with the aid of a dynamic orthosis. Tests were administered before and after training. Functional capacity was assessed using the TEMPA (Test d'Évaluation des Membres Supérieurs de Personnes Âgées) test. The Wilcoxon test was used for pre-training and post-training comparisons of TEMPA scores. The volunteers showed significant improvement of upper extremity function in the performance of a bilateral task (p = 0.01) and three unilateral tasks (p = 0.04). This pilot study suggests that the dynamic orthosis associated with the performance of functional tasks can have positive outcomes regarding the improvement of functional capacity of upper extremity.