Index Of Recovery Research Articles

Lipids and lipoproteins of malnourished children during early renutrition: apoliprotein A‐IV as a potential index of recovery I EL HARIM, J BEFORT, A BALAFREJ, ET AL Universite Mohamed V Laboratoire de Biochimie, Rabat, Morocco, and Inserm U286 Faculte Xavier Bichat, Paris

Lipids and lipoproteins of malnourished children during early renutrition: apoliprotein A‐IV as a potential index of recovery I EL HARIM, J BEFORT, A BALAFREJ, ET AL Universite Mohamed V Laboratoire de Biochimie, Rabat, Morocco, and Inserm U286 Faculte Xavier Bichat, Paris

Transmitter-loaded polymeric microspheres induce regrowth of dopaminergic nerve terminals in striata of rats with 6-OH-DA induced parkinsonism

Biodegradable controlled-release microspheres made with the biocompatible biodegradable polyester excipient poly (DL-lactide-co-glycolide) represent a new technology for drug delivery to the central nervous system (CNS). A suspension of 3 μl of dopamine (DA) or NE containing microspheres, or empty microspheres, was implanted in 2 sites of the DA denervated striatum of rats previously unilaterally lesioned with 6-OH-DA. Contralateral rotational behavior induced by apomorphine was used as an index of lesion success. Following implantation of the microspheres, rotational behavior was also used as an index of functional recovery. Both DA and NE microsphere implanted rats displayed a 30–50% reduction in the number of apomorphine induced rotations up to 12 weeks post implantation. Empty microspheres caused no changes in rotational behavior. Implantation of a mixture of DA/NE microspheres resulted in an 80% decrease in the number of apomorphine induced rotations, registered up to 4 weeks. Immunocytochemical examination revealed growth of DA and tyrosine hydroxylase immunoreactive fibers in the striatum of DA and NE microsphere implanted rats. Interestingly, functional behavior correlated with the degree of fiber ingrowth. This method to deliver substances to the CNS will be tested for therapeutic usefulness in patients with Parkinson's disease, in a recently approved clinical trial in Göteborg.

Comparative study of evoked electromyography and facial nerve latency test in the prognosis of idiopathic facial nerve palsy in childhood

We report our results from the application of evoked electromyography (EEMG) and facial nerve latency testing (FNLT) in 30 children aged 4-14 years with idiopathic facial palsy. Our aim was to define the value of these tests as prognostic tools in Bell's palsy. From the EEMG results we ascertained that, when the amplitude of the compound muscle action potential varied between 51% and 95% of the normal value, the neuronal damage is slight (neurapraxia). When the percentage value of muscle response decreases, the prognosis is worse. The results of the FNLT showed that, when the latency is within normal limits, the damage to the nerve is slight (neurapraxia). If the latency is prolonged, the prognosis is worse. Evaluation of our results and comparison with the index of facial nerve functional recovery showed that those two tests have a high percentage of correctness (100% for the EEMG and 96.7% for the FNLT) and a low percentage of error. We conclude that these tests are excellent for predicting the outcome of facial nerve palsy in childhood and we suggest that young patents undergo both so that the determination of the lesion may be as correct as possible.

Decrease and Recovery of Ejaculated Sperm Concentration after Acute Testicular Gamma-Ray Irradiation in Cynomolgus Monkeys (Macaca fascicularis).

After acute testicular irradiation in adult male cynomolgus monkey semen was periodically collected, and sperm concentration was examined as an index of radiation damage to the seminiferous epithelium. Sperm concentrations decreased after irradiation with 1, 2, or 3 Gy. Concentrations fell below the minimum normal level for unirradiated monkeys, (107 sperm /ml of semen [13]) at 16.0, 8.5, and 8.0 weeks after irradiation, respectively. The lowest sperm concentra-tion was observed 17.0, 12.5, and 14.0 weeks after irradiation, and the percentages of the lowest sperm concentration relative to the pre-irradiation concentration were 1.20, 1.37, and 0.20%, respectively. The sperm concentration recovered to pre-irradiation levels after 35.5, 36.5 and 41.0 weeks at doses of 1, 2 and 3 Gy, respectively. These results indicate that spermatogenesis decreases markedly after irradiation with 1-3 Gy but resumes after a definite period that depends on the radiation dose. Sperm concentration can be utilized as an effective index of radiation damage to the seminiferous epithelium and as an index of recovery.

Electrical stimulation of nerve regeneration in the rat: functional evaluation by a twitch tension method

The effect of D.C. electrical fields on in vivo nerve regeneration following rat sciatic nerve transection was assessed by a toe-twitch tension method for motor recovery. Two groups for baseline comparisons received either a nerve transection and a neutral battery implant or a nerve crush and no implant. Two treatment groups each received a nerve transection and an implant delivering either cathodal (-10 μA) or anodal (+10 μA) current via electrodes positioned on either side of the transection site. The contralateral nerve was exposed but not given a lesion. The functional recovery was assessed at weekly intervals by comparing the amplitude and area of the twitch tension curves on both sides, expressed as a ratio (index of motor recovery = IMR). By 28-35 days postoperative (dpo) the crushed/untreated group had mean IMR values not significantly different than the preoperative values. The transected/neutral group appeared to have the worst recovery throughout the study. Compared to these two groups, both the cathodal and anodal treatment groups with a transected nerve showed intermediate IMR values, but by 63 dpo the group differences were less. These results indicate that following a nerve transection lesion steady D.C. electrical fields may temporarily enhance the early functional recovery of motor nerve regeneration compared to conventional nerve repair alone.

Investigation and evaluation of zinc protoporphyrin as a diagnostic indicator in lead intoxication

To evaluate the utility of zinc protoporphyrin (ZPP) as an indicator of lead exposure, we examined 128 workers employed at a battery storage plant and two smelters, 343 persons who lived within 200 m of the plants, and 217 controls. Based on Chinese criteria, the "normal" ZPP value among inhabitants of Shaanxi Province was determined to be 85 micrograms/100 ml. ZPP proved to be a more sensitive and specific indicator of lead exposure, at both high and lower levels, than PbB or PbU. Among 115 patients who underwent chelation therapy for lead poisoning, ZPP also proved to be a valid index of recovery.

Lipids and lipoproteins of malnourished children during early renutrition: apolipoprotein A-IV as a potential index of recovery

Twenty-six children with marasmus and 27 with kwashiorkor were compared with 23 control children of matching ages. Kwashiorkor was characterized by increased phospholipids (NS), low (P < 0.01) apolipoprotein (apo) B-rich LDL, and near normal apo A-I and HDL-C. In children with marasmus apo B (P < 0.02) LDL-C (NS), apo A-I (P < 0.01), and HDL-C (P < 0.001) decreased. Fifteen children in each group were followed for 2 wk. Control values were progressively reached after 2 wk. In the younger children final apo B was higher than in control subjects (P < 0.03) but apo A-I was identical. Apo A-IV, assayed because it correlates with the functional state of intestine, was near normal in children with kwashiorkor and decreased with treatment. In children with marasmus apo A-IV decreased by 50%, increased with treatment in older children, but further diminished in younger children. After 2 wk apo A-IV was significantly lower in all patients than in control subjects. Apo A-IV, by remaining depressed after other variables normalized, seems a good index of nutritional status.

Electrical field effects on crushed nerve regeneration

The delivery of an electrical field to a transected nerve has been shown to enhance the regeneration. This study examined the effects of such fields on the regeneration of crushed rat sciatic nerve during the first postoperative month. The treated (T) nerve group received a battery implant delivering 10 μA with the cathode at the distal stump. The recovery was compared to an untreated (UT) group and unoperated controls (C). The loss of locomotion behavior and partial recovery (SFI) was identical for the T and UT groups. The index of motor recovery (twitch tension) was also similar ( T C = 48%, UT C = 53% ), but a “window” of enhancement occurred 2–4 days earlier in the T group. Qualitative histology at 28 days suggested a more healthy and normal-appearing nerve in the T group. Morphometric analysis indicated that the nerve area, fiber density, and fiber number in the T group were more similar to those in the control group than to those in the UT group. There were no group differences in the number of HRP-labeled motoneurons, but the enlarged endoneurial space was significantly reduced in the T group compared to the UT group. In conclusion, electrical fields appeared to have a small effect on some aspects of nerve regeneration following crush injury.

Relation between recovery sequence estimated from body surface potentials and T wave shape in patients with negative T waves and normal subjects.

Advances in analytical methods of the epicardial electrical potentials allowed us to demonstrate spatial distributions of local recovery. Because local recovery will be reflected in events on body surface ECG mapping, abnormalities in recovery sequence that may be responsible for the origin of negative T waves can be detected from body surface potentials. Eighty-seven unipolar ECGs were recorded simultaneously from the entire thorax in patients having negative T waves on left anterior precordial leads and in normal subjects. These included 40 patients with anterior myocardial infarction (MI), 21 patients with left ventricular hypertrophy (LVH), and 44 male volunteers. We measured Tmax time, defined as the instant of maximal first derivative of the T wave as the index of local recovery (Wyatt's method). Parameters related to T wave potentials were positive T wave amplitude, negative T wave amplitude, and T integral. Significant correlations were observed between the Tmax time and each of the T wave potentials. The T wave potentials were dependent on Tmax times. In the anterior MI, the late Tmax times were located on the upper left anterior chest and early Tmax times on the lower right lateral chest. In the LVH, the area showing a delayed recovery was displaced in a left downward direction compared with anterior MI. Body surface Tmax time distributions clearly separate two negative T wave groups, i.e., anterior MI and LVH. Appearance of the negative T waves correlates well with the presence of the area with delayed Tmax time on the spatial distribution.

P42 Alpha reactivity as a prognostic index of recovery after stroke

P42 Alpha reactivity as a prognostic index of recovery after stroke

Differential recovery of skeletal muscle and peripheral nerve function after ischemia and reperfusion

Recovery of skeletal muscle function is of prime importance in revascularization of acutely ischemic extremities. In order to study the effect of ischemia and reperfusion on peripheral nerve and skeletal muscle function, temporary unilateral hindlimb ischemia (1 or 3 hr) was induced in 12 rabbits by temporary arterial occlusion of common iliac and femoral arteries and collateral ligation. The control limb was similarly prepared without interruption of blood flow. Both anterior tibialis muscles were attached to force transducers, and the twitch and tetanic tensions were measured at the end of the ischemic interval and during reperfusion (2 hr) by either direct muscle stimulation or stimulation of the deep peroneal nerve. The ischemic limb was reperfused by removal of arterial clamps and reperfusion documented by Doppler flow over the vascular pedicle. The recovery of muscle function of the ischemic/reperfused limb relative to that of the contralateral control limb was used as the index of recovery. By the end of the ischemic interval, no contractile activity was elicited with nerve stimulation for either the 1- or the 3-hr group. After 2 hr of reperfusion, the 1-hr group regained 0.558 ± 0.116 (mean ± SEM) of control function with nerve stimulation, while the 3-hr group regained only 0.016 ± 0.005 of control function ( P < 0.01). In contrast, with direct muscle stimulation, the 1-hr group produced 0.580 ± 0.015 compared to 0.286 ± 0.042 ( P < 0.001) after 3 hr of ischemia. After 2 hr of reperfusion, the 1-hr group recovered 0.805 ± 0.059 of muscle function which was significantly better than 0.580 ± 0.077 ( P < 0.05) for the 3-hr ischemia group. Therefore, peripheral nerve is more susceptible to ischemia and short reperfusion intervals than skeletal muscle. Strategies for revascularization that may prove beneficial in the treatment of acute severely ischemic limbs may need to take into account the demonstrated injury of peripheral nerve function following relatively short periods of ischemia.

Alcuronium Pharmacodynamics in Dogs

Previous studies suggest that the muscles of the diaphragm are less sensitive to neuromuscular blocking agents than the limb muscles. However, this difference has not been characterized directly in terms of relaxant drug plasma concentrations. The pharmacodynamics of the non-depolarizing muscle relaxant alcuronium were therefore investigated in nine dogs using a constant-rate infusion regimen with simultaneous measurement of muscle paralysis in the limb and diaphragm. Maximum paralysis between 95 and 100% was achieved in both muscle groups, within approximately the same time interval. However, during onset of and offset of effect, the pharmacodynamic parameters ECp50 and ECp95 for the limb muscle were lower than in the diaphragm. From a pharmacodynamic effect model it was also predicted that Css(50) and Css(95) for the limb muscles are half those values for the diaphragm. Thus, the diaphragm is less sensitive to the action of alcuronium than are limb muscles. The half-time for equilibration of alcuronium between plasma and the effect site was two-fold lower for the diaphragm, and the rate of recovery from paralysis in diaphragmatic muscles was twice that observed in limb muscles. Collectively, these data suggest that there is a greater margin of safety in the diaphragmatic muscles and that the response of the peripheral limb muscles to nerve stimulation provides only a conservative index of recovery from competitive neuromuscular block in the diaphragmatic muscles.

PSYCHOLOGICAL RECOVERY OF ACCIDENT VICTIMS WITH TEMPORARY AND PERMANENT DISABILITY

The main objective of this study was to examine the role of causal beliefs in the psychological recovery of temporarily and permanently disabled accident victims. Patients (N = 41) from a government hospital and private nursing homes in Allahabad city, India, were interviewed one week and three weeks after the accident. The doctor's report of their recovery was also obtained each time. The permanently disabled patients were found less motivated to search for the causes of the tragic event. When asked to make attribution, permanently disabled attributed the accident more to external factors than those who were temporarily disabled. Chance and God's will were the causes more frequently mentioned. Attributions to Karma and God's will were significantly correlated with psychological recovery. The sense of personal control was not found to be a good index of psychological recovery. Number of complaints made by the patients and their depressive symptoms, as observed by the doctors, negatively correlated with the psychological recovery.

Regional Cerebral Blood Flow (rCBF) as an index of recovery in abstinent alcoholic patients: Some case examples : Kenneth M. Adams, Robert Simkins (Henry Ford Hospital), Igor Grant, and Robert Reed (San Diego Veterans Administration Medical Center)

Regional Cerebral Blood Flow (rCBF) as an index of recovery in abstinent alcoholic patients: Some case examples : Kenneth M. Adams, Robert Simkins (Henry Ford Hospital), Igor Grant, and Robert Reed (San Diego Veterans Administration Medical Center)

Regional Cerebral Blood Flow (rCBF) as an index of recovery in abstinent alcoholic patients: Some case examples

Regional Cerebral Blood Flow (rCBF) as an index of recovery in abstinent alcoholic patients: Some case examples

Changes in plasma fibronectin during donor apheresis and therapeutic plasma exchange.

Changes in plasma levels of the opsonic glycoprotein fibronectin were studied during machine apheresis in 32 healthy plasma donors and 18 patients undergoing a total of 86 therapeutic plasma exchanges. Donation of 500 ml of plasma at 3-monthly intervals produced a 10% immediate decrease in plasma fibronectin with no evidence of a long-term affect on levels of this protein. One plasma volume exchange with fibronectin-poor plasma protein fraction produced subnormal plasma fibronectin levels in 98% of post-exchange samples. Efficiency of exchange was significantly lower in patients with paraproteinaemia, probably reflecting increased plasma volume in such patients. Daily plasma exchange produced progressive depletion of plasma fibronectin (index of recovery 0.68) whereas levels were maintained close to the initial value with longer exchange intervals, except in the more severely ill patients. Reduction of plasma fibronectin by plasma exchange may increase susceptibility to infection and reduce the efficacy of this procedure when the object of exchange is to reverse reticuloendothelial blockade.

ATP-MgCl2 produces sustained improvement in hepatic mitochondrial function and blood flow after hepatic ischemia.

Recent studies have shown that infusion of ATP-MgCl2 following hepatic ischemia significantly improved mitochondrial function and hepatic blood flow 1 hr after treatment. To determine if the improvement in the above parameters by ATP-MgCl2 is short-lived or whether it persists for prolonged periods of time after treatment, hepatic ischemia in rats was produced for 90 min followed by reperfusion. The rats then received iv 0.5 ml of saline or ATP-MgCl2 (12.5 mumole each). Twenty-four hours after reflow, hepatic blood flow was measured by H2 polarography following which the animals were sacrificed and hepatic mitochondria isolated. The results indicated that 24 hr after reflow, mitochondrial state 3 respiration, respiratory control ratio, adenine nucleotide translocase activity, ATP synthetic activity, and hepatic blood flow were depressed by approximately 50% in animals which were treated with saline after hepatic ischemia. In addition, there was a fourfold increase in mitochondrial free fatty acid levels of such animals. Animals which were treated with ATP-MgCl2 following hepatic ischemia showed significantly improved mitochondrial function (used as an index of cellular recovery) and hepatic blood flow. These results in conjunction with previous results suggest that infused ATP-MgCl2 improves mitochondrial function and blood flow and that these effects persist even 24 hr after administration of ATP-MgCl2. Thus, infusion of ATP-MgCl2 following severe ischemia produces sustained improvement in cellular function.

Early discharge and return to work following myocardial infarction

Individuals who have experienced a myocardial infarction (MI) account for the largest component of all hospitalization costs and foregone earnings due to cardiac disease. Early return to full employment and premorbid activity level should be the focus of cost-effective rehabilitative programs. Yet the economic benefits of vocational rehabilitation have not been directly researched. Therefore, issues of import regarding activity after MI include the timing of ambulation, discharge and return to work. Studies of early mobilization and discharge are contrasted in terms of methodology and outcome. These cite economic, social and psychological advantages, yet these factors are examined in isolation of other variables. A review of the literature reveals that there is a reluctance by many health professionals to institute such practices based in part on the dilemma surrounding selection of specific indicators and risk factors. Yet analysis reveals that the contention surrounding these exclusion criteria is perhaps unfounded, as the variance is less than is commonly assumed. Recurrent themes likewise emerge regarding the multiplicity of variables associated with the timing of resumption of employment, which is considered to be the most precise index of recovery following an MI. Of these, only early intense rehabilitation, directed at attitudinal and behavioural change, is amenable to modification by health professionals. Related research endeavours have examined employment following aortocoronary bypass surgery, risk factors in the work environment and work stressors which occur following MI. Controversy arises regarding the correlation of age and personality factors with return to work. Discrepancies in research findings are attributed to the diverse approaches to data collection, obstacles encountered in measuring psychological states, lack of operational definitions, differences in degree of rehabilitation and length of follow-up and the absence of controlled trials. Clearly, experimental research focusing on the job-related economic and human cost impact of specific rehabilitation programs must be conducted. Three strategies are identified which should facilitate return to premorbid levels of activity, including (1) the definition, development and integration of roles of diverse professionals within the interdisciplinary health care team, (2) the early detection and modification of psychological problems, physical disability and inappropriate occupations which would prevent MI patients from returning to their former occupations and (3) prompt follow-up and comprehensive structured rehabilitation programs which incorporate education, exercise and emotional support at the individual, family and community level. This analytical survey supports the principle of early mobilization, discharge and return to employment or premorbid state, yet operational definitions and deadlines are only in the infancy stage. Multidisciplinary experimental efforts must be directed toward the detection of significant variables and generalizable rehabilitation mechanisms. The process of programs requires testing as do the emotional, physical and health outcomes.

Delayed recovery following hypothermic arrest in rabbit myocardium.

The purpose of this investigation was to determine the relationship between the duration of myocardial ischemia at 15 degrees C and the time required for the myocardium to recover maximum contractile function following the ischemia. The isolated blood perfused rabbit heart was used as a model of myocardial ischemia. Hearts from 22 New Zealand white rabbits were divided into four groups. In Group I seven hearts were subjected to 15 minutes of ischemia at 15 degrees C. In Group II five hearts were subjected to 30 minutes of ischemia at 15 degrees C. In Group III and IV the ischemia time was extended to 60 and 120 minutes, respectively. Following the ischemia each heart was reperfused at normothermia and papillary muscle contractility was measured and used as an index of myocardial recovery. Hearts in Group I recovered their maximum contractile function after an average of 22.5 minutes. Those in Groups II, III, and IV were fully recovered after 31.7, 38.2, and 45.5 minutes, respectively. The study indicates that the time required for the maximum recovery of myocardial contractility following myocardial ischemia increases at a decreasing rate with an increase in the duration of the ischemia at 15 degrees C.

Use of 100-Hertz Tetanus as an Index of Recovery from Pancuronium-Induced Non-depolarizing Neuromuscular Blockade

During recovery from non-depolarizing neuromuscular blockade the evoked response to train-of-four (TOF), 100-HZ tetanus (T100) and 50-HZ tetanus (T50) was measured in 10 patients. When the TOF fade ratio exceeded 0.70, tetanic tension to T50 was well sustained. However, even at TOF ratios as high as 0.88 a 2-second tetanic response to T100 showed marked fade. T100 stimulation appears to be too sensitive a test to residual curarization for routine clinical use. Fade on T100 may be quite apparent at a time when the use of additional neuromuscular antagonists are not indicated and may be counterproductive.