Good Early Recovery Research Articles

Arachidonic acid level is related to early motor recovery following intracerebral hemorrhage with severe motor paralysis

BackgroundLow arachidonic acid (AA) levels are reportedly associated with unfavorable outcomes in intracerebral hemorrhage (ICH). ObjectiveWe aimed to clarify whether serum AA levels might be associated with a good recovery from severe motor paralysis in the early stage of hospitalization. MethodsFrom among consecutive ICH patients between October 2012 and December 2021, patients with a sum of upper and lower extremity National Institutes of Health stroke scale (NIHSS) scores of 4–8 at admission (severe motor paralysis) were included. We defined good early recovery from severe motor paralysis as a sum of upper and lower extremity NIHSS scores of 0–3 on day 7 after admission, and that of individual upper and lower extremities as NIHSS scores of 0–1 on day 7 after admission. We aimed to assess whether serum AA levels might be associated with good early recovery from severe motor paralysis. ResultsWe screened 377 consecutive ICH patients, including 140 with severe motor paralysis (88 (63%) males, median age 64 years). Recovery from severe motor paralysis was seen in 48 (34%). Higher AA levels (PR 1.243, 95% CI 1.042 to 1.483, p = 0.016) were independently associated with good overall recovery, and good recovery of upper and lower extremities separately (upper extremity: PR 1.319, 95% CI 1.101 to 1.580, p = 0.003; lower extremity: PR 1.293, 95% CI 1.115 to 1.499, p = 0.001). ConclusionsHigher AA levels may contribute to a good early motor recovery in patients with severe motor paralysis due to ICH.

25, 50 and 75 years ago

25, 50 and 75 years ago

Current characteristics and early functional outcome of older stroke patients: a population-based study (Dijon Stroke Registry).

the ongoing growing and ageing population is associated with an increase in older patients suffering a stroke. We aimed to assess the current profile of these patients in a population-based setting. all patients with acute stroke were prospectively identified among residents of Dijon, France, between 2013 and 2017, using a population-based registry. Characteristics and early outcome of patients were compared according to age groups. 1,288 stroke cases were recorded (median age: 81.1years, interquartile range: 66.1-86.7, 54% women). Patients aged 75-85years and those >85years accounted for 27.6 and 33.9% of overall cases. Increasing age was associated with a greater prevalence of vascular risk factors, pre-existing cognitive impairment and handicap, higher initial severity, more frequent cardioembolic ischemic stroke, post-stroke pulmonary infection and delirium. Only 41% of patients aged 75-85years and 18% of those aged >85years had a good early recovery. Compared with patients aged <75years, patients aged 75-85years [adjusted odds ratio (OR) = 2.61; 95% confidence interval (CI): 1.74-3.93, P < 0.001] and those aged >85years (adjusted OR = 7.18; 95% CI: 4.58-11.3, P < 0.001) had an increased risk of poor post-stroke functional outcome. Among survivors, the proportion of patients discharged to home was 60% in age group <75years, compared with 49% in patients aged 75-85years and 29% in those aged >85years. Thirty per cent of patients >85years old required a long-term care institution. the increasing burden of stroke in older people has major implications for future treatment strategies and need for dedicated care facilities.

αβ-T-cell-depleted haploidentical hematopoietic stem cell transplantation in children with chemorefractory acute myeloid leukemia

Primary refractory and relapsed refractory acute myeloid leukemia remains an unresolved problem in pediatric oncology. Children with AML who fail to achieve complete remission on high-dose cytarabine and antracyclines have no chance for survival without allogeneic hematopoietic stem cell transplantation. We evaluated the outcome of αβ-T-cell-depleted haploidentical transplantation in a cohort of children with chemorefractory acute myeloid leukemia. Thirty-six patients with either primary refractory (n = 14) or relapsed refractory (n = 22) acute myeloid leukemia in active disease status received a transplantation from haploidentical donors. The preparative regimen included cytoreduction with fludarabine and cytarabine and subsequent treatment with treosulfan and either melphalan or thiophosphamide. Serotherapy consisted of antithymocyte globuline in 14 pts and targeted immunomodulation with tocilizumab +/- abatacept in 22 pts. Grafts were PBSCs engineered by TCR-αβ/CD19 depletion. Posttransplant preemptive therapy included modified donor lymphocyte infusions with or without hypomethylating agents. Complete remission was achieved in 30 (83%) рts. The cumulative incidence of acute GVHD grade II–IV was 25%, and the cumulative incidence of chronic GVHD was 18%. Transplant-related mortality was 6%, and relapse incidence was 48%. Event-free survival was 46%, and overall survival was 41% at 2 years. Good early recovery of NK cells was associated with significantly improved survival and decreased relapse incidence. Our data suggest that αβ-T-cell-depleted haploidentical HSCT provides a reasonable chance of cure in a cohort of children with chemorefractory acute myeloid leukemia and creates a solid basis for further improvement. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology.

Early recovery and employment outcome 13 years after first episode psychosis

175 cases of first episode psychosis were recruited to the Parachute project in 1996–97. The program offered highly available and continuous psychosocial support and a cautious use of antipsychotic medication for 5 years from inclusion.Outcome-data for year 13 after inclusion, were retrieved from Swedish population registries on 161 of the original cases.During the first year after inclusion the cohort improved in the scores of the Brief Psychiatric Rating Scale (BPRS) and Global Assessment of Function (GAF) to median levels that later remained rather stable. By month 12 the median GAF score was 65. 68% of the cases were in remission from psychotic symptoms as assessed with BPRS. 38% of the cases in remission and 60% not in remission had prescriptions of antipsychotic medication by month 12.By year 13 after inclusion, 42% were in employment and 55% had any dispensation of antipsychotic medication. 70% of the cases with employment had no dispensations of antipsychotic medication.In conclusion, Many first episode psychosis cases that were offered extensive psychosocial support and cautious use of antipsychotic medication had good early recovery and good late employment outcome.

Dissociation of severity of stroke and aphasia recovery early after intravenous recombinant tissue plasminogen activator thrombolysis

Clinical observation suggested to us that aphasia recovers relatively better than other deficits early after intravenous recombinant tissue plasminogen activator (IV-rtPA) treatment in stroke patients with minor deficits, while the reverse seemed the case in those with severe deficits. Retrospective analysis of acute ischemic stroke patients with aphasia admitted within 3hours from symptom onset and treated with IV-rtPA was carried out. Stroke severity, aphasia and global neurological impairment were assessed at admission and 24hours after thrombolysis. Improvement of aphasia (gain of ⩾1 point on the National Institutes of Health Stroke Scale [NIHSS] aphasia score) and global neurological improvement (gain of ⩾4 points on the NIHSS) were compared in minor strokes (NIHSS ⩽7), moderate strokes (NIHSS 8–15), and major strokes (NIH ⩾16). Sixty-nine of 243 stroke patients suffered from aphasia. Improvement of aphasia occurred in 7/16 minor strokes, 11/25 moderate strokes, and 7/28 severe strokes. Improvement of ⩾4 points on the NIHSS occurred in 3/16 minor strokes, 17/25 moderate strokes and 15/28 severe strokes. There is a significant (X2=4.073, p<0.05) dissociation of recovery of aphasia and that of other neurological deficits between minor versus severe strokes. This confirms the clinically suspected dissociation between a good early recovery from aphasia in minor strokes relative to recovery of other neurological deficits, as opposed to a better recovery from other neurological deficits than from aphasia in patients with severe strokes.

Message passing interface and multithreading hybrid for parallel molecular docking of large databases on petascale high performance computing machines

A mixed parallel scheme that combines message passing interface (MPI) and multithreading was implemented in the AutoDock Vina molecular docking program. The resulting program, named VinaLC, was tested on the petascale high performance computing (HPC) machines at Lawrence Livermore National Laboratory. To exploit the typical cluster-type supercomputers, thousands of docking calculations were dispatched by the master process to run simultaneously on thousands of slave processes, where each docking calculation takes one slave process on one node, and within the node each docking calculation runs via multithreading on multiple CPU cores and shared memory. Input and output of the program and the data handling within the program were carefully designed to deal with large databases and ultimately achieve HPC on a large number of CPU cores. Parallel performance analysis of the VinaLC program shows that the code scales up to more than 15K CPUs with a very low overhead cost of 3.94%. One million flexible compound docking calculations took only 1.4 h to finish on about 15K CPUs. The docking accuracy of VinaLC has been validated against the DUD data set by the re-docking of X-ray ligands and an enrichment study, 64.4% of the top scoring poses have RMSD values under 2.0 Å. The program has been demonstrated to have good enrichment performance on 70% of the targets in the DUD data set. An analysis of the enrichment factors calculated at various percentages of the screening database indicates VinaLC has very good early recovery of actives.

(P2-70) A Systematic Search and Narrative Review of Existing Literature on the Medium and Long-Term Impact of Injuries

BackgroundA systematic search and narrative review of existing literature on the medium- and long-term impacts of injuries was conducted to provide context for a primary research study.MethodsSearches were undertaken in MEDLINE, CINHAL and Science Citation Index using a combination of free text and Medical Subject Heading (MeSH) terms. Studies were included if they assessed outcomes following injury at least six months post-injury and reported morbidity-related outcomes. A standardized data extraction form was developed, and studies were assessed for quality using standard quality assessment criteria. The main characteristics of included studies were presented in structured tables and synthesized using a narrative summary.ResultsThe search strategy identified 4,969 abstracts and/or titles, of which 125 appeared relevant. Following a detailed reading of the material, 32 studies met the inclusion criteria of this review. Summarizing the results of the studies was difficult, as they were of moderate quality and used many different methods. The main findings were that at 12 months post-injury a proportion of injured patients continue to suffer from physical, psychological, and social problems and this proportion doesn't decline over the next few years. In the medium term (12 months–5 years) about 10–25% of casualties continue to report a variety of health problems associated with their injuries.ConclusionsIt is difficult to synthesize injury outcome studies because of the varying methodological approaches, study populations, follow-up periods, and outcome measures used. The evidence that exists suggests that many casualties demonstrate good early recovery but a significant proportion still show significant social, physical, and psychological sequelae one to five years post-injury.