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Significant potential exists for enhancing physical rehabilitation following neurologic injury through the use of robotic and mechatronic devices (or "rehabilitators"). We review the development of a rehabilitator (the "ARM Guide") to diagnose and treat arm movement impairment following stroke and other brain injuries. As a diagnostic tool, the ARM Guide provides a basis for evaluation of several key motor impairments, including abnormal tone, incoordination, and weakness. As a therapeutic tool, the device provides a means to implement and evaluate active assist therapy for the arm. Initial results with three stroke subjects demonstrate that such therapy can produce quantifiable benefits in the chronic hemiparetic arm. Directions for future research regarding the efficacy and practicality of rehabilitators are discussed.

Significant potential exists for enhancing physical rehabilitation following neurologic injury through the use of robotic and mechatronic devices (or 'rehabilitators'). We review the development of a rehabilitator (the 'ARM Guide') to diagnose and treat arm movement impairment following stroke and other brain injuries. As a diagnostic tool, the ARM Guide provides a basis for evaluation of several key motor impairments, including abnormal tone, incoordination, and weakness. As a therapeutic tool, the device provides a means to implement and evaluate active assist therapy for the arm. Initial results with three stroke subjects demonstrate that such therapy can produce quantifiable benefits in the chronic hemiparetic arm. Directions for future research regarding the efficacy and practicality of rehabilitators are discussed. [ABSTRACT FROM AUTHOR]

A patient with systemic lupus erythematosus was first diagnosed after she had developed the Budd-Chiari syndrome. We believe that the Budd-Chiari syndrome was part of her tendency for thrombosis, induced by the presence of a lupus anticoagulant. The association between enhanced thrombosis and the lupus anticoagulant is discussed, and the need for prompt recognition and administration of anticoagulant therapy is emphasised. [ABSTRACT FROM PUBLISHER]

Presents a study that evaluated the effects of the theophylline derivative aminophylline during bradyasystolic arrest refractory to conventional therapy. Assessment of the immediate response of the patients to aminophylline; Analysis of the short-term health outcome of the patients studied; Examination of electrocardiographic recordings from the patients.

Background: Arterial stiffness (AS) and highly sensitive CRP (hsCRP) predict risk for cardiovascular events. Statins can improve inflammation and AS. The effect of ezetimibe on AS and hsCRP has not been studied. The aim of this study was to compare the effect of simvastatin with ezetimibe on AS and hsCRP.Methods: Forty hypercholesterolemic patients were studied. Group 1: previously untreated received simvastatin 40mg/d, group 2: previously treated with simvastatin 40mg/d received simvastatin 80mg/d; group 3: previously untreated received ezetimibe 10mg/d; group 4: previously treated with simvastatin 40mg/d received simvastatin 40mg/d and ezetimibe 10mg/d. Augmentation index (AIx, a measure of AS), and hsCRP were measured at baseline and after 3 months.Results: The reduction in LDL after treatment was significantly greater in groups 1 and 4 (39% and 37%) compared to groups 2 and 3 (18% and 16%). AIx decreased significantly in group 1 compared to the other groups (−22.1%, −0.4%, −0.3% and 0.4% in groups 1-4, p=0.035). Changes in hsCRP paralleled the changes in AIx: significant decreased in group 1 (−50.8%), compared to group 2 (+3.6%), p=0.002. In groups 3 and 4 hsCRP decreased, but there was no significant difference (−21.3% and −11.3%, p=0.81).Conclusions: Compared to simvastatin, ezetimibe as monotherapy resulted in milder decreases in LDL cholesterol and had no effects on AS or hsCRP. Increasing the dose of simvastatin or the addition of ezetimibe to simvastatin had no beneficial effects on AS or hsCRP.Clinical Pharmacology & Therapeutics (2005) 79, P1–P1; doi: 10.1016/j.clpt.2005.12.003 [ABSTRACT FROM AUTHOR]

Background: The purpose of this analysis was to assess the relation between pain relief evaluation by subjects with acute pain following analgesic medication and the time elapsed to obtain pain relief.Methods: We performed a raw data analysis of 304 subjects included in a clinical trial submitted to the Food and Drug Administration using the third molar post extraction dental pain model. The study was a randomized, double-blind, controlled trial. Eligible subjects were otherwise healthy men or nonpregnant women older than 16 years of age. The primary end point analyzed was the time to meaningful pain relief. The study design has been approved by the responsible IRB.Results: The study population included 187 females and 117 males. Our breakout has been between responders and nonresponders. Pain relief responders rated the drug mainly as excellent or good. Median time for drug responders to achieve meaningful pain relief showed that 110 subjects who reported an excellent response, reported it 28 minutes following medication, 85 subjects who reported a good response, reported it 48 minutes following medication, and 19 subjects who reported a fair response, did it 60 minutes following medication. Nonresponders mainly rated the drug they took as poor or fair anytime following medication.Conclusions: Faster median response to achieve meaningful pain relief has related to the drug efficacy evaluation. It clearly demonstrates that more rapid pain relief is associated with a better rating of the drug.Clinical Pharmacology & Therapeutics (2005) 79, P59–P59; doi: 10.1016/j.clpt.2005.12.214 [ABSTRACT FROM AUTHOR]

Although autoimmune diseases (AIDs) are known to predispose to non-Hodgkin lymphoma (NHL), their association with NHL prognosis has rarely been investigated. We examined associations between autoimmunity and B-cell NHL onset by comparing AID history (determined by self-report and medication review and supplemented by chart review where possible) among 435 adult B-NHL patients in Hadassah-Hebrew University Medical Center, diagnosed 2009-2014, and 414 age-and-sex frequency-matched controls. We examined AIDs as a whole, B- and T-cell-mediated AIDs, and autoimmune thyroid diseases. Among cases, we used Kaplan-Meier and Cox regression models to assess the association of AID with overall survival and relapse-free survival, adjusting for prognostically important patient and disease characteristics such as Ki67% staining, International Prognostic Index, rituximab treatment, and histological subgroup. Autoimmune diseases were associated with B-NHL (odds ratio [OR] = 1.95; 95% confidence interval (CI), 1.31-2.92), especially AIDs mediated by B-cell activation (OR = 5.20; CI, 1.90-14.3), which were particularly associated with marginal zone lymphoma (OR = 19.3; CI, 4.59-80.9). We found that time to relapse for all B-NHL patients with AIDs was significantly shorter (mean of 49.21 mo [±3.22]) than among patients without AID (mean of 59.74 mo [±1.62]), adjusted hazard ratio [HR adj ] = 1.69 (CI, 1.03-2.79). Specifically, in patients with diffuse large B-cell lymphoma, of whom 91.8% had received rituximab, a history of B-cell-mediated AIDs was associated with shorter relapse-free survival and overall survival, HR adj  = 8.34 (CI, 3.01-23.1) and HR adj  = 3.83 (CI, 1.20-12.3), respectively. Beyond confirming the well-known association between AIDs and B-NHL, we found that AID is an adverse prognostic factor in B-cell lymphoma, associated with a shortened time to relapse, suggesting that there are specific therapeutic challenges in the subgroup of patients suffering from both these diseases. Further work is required to address mechanisms of resistance to standard treatment in the setting of AID-associated B-NHL. In the era of immunotherapy, these findings have particular relevance., (Copyright © 2018 John Wiley & Sons, Ltd.)

There is disagreement in the literature regarding which scales to use in pain measurement. The difference has usually been between nonverbal scales, such as visual analog scales and verbal ones, which usually provide only a limited number of response categories. A 12-week, randomized, double-blind naproxen sodium (500 mg bid) and placebo-controlled trial using the hip osteoarthritis (OA) flare-up pain mode, in which pain was measured on both visual analog and categorical scales simultaneously, was analyzed. The authors found a good correlation (> 0.995) between the time-series average of the unconstrained visual analog scale and a 5-point categorical scale pain measurement in the osteoarthritis pain model in both active and placebo treatment arms. However, for individuals, there is a wide range of VAS responses for each categorical score, with overlaps between categories. The visual analog and categorical scales appear as effective in determining average osteoarthritis pain. However, a combined metric scale for pain measurement that provides the subject with multiple cues may improve communication and concordance between scales for individual pain determination.

We present a 75-year-old patient with recurrent palpable purpura and multiorgan involvement by leukocytoclastic vasculitis caused by mixed-type cryoglobulinemia. The disease spanned 40 years, with many flare-ups, each associated with thrombocytopenia, and finally culminated in widespread involvement of not only the skin and the kidneys but also the lungs and spleen. Despite extensive investigation, no association with hepatitis C virus or with any malignant or connective tissue disorder was found.

Unlabelled: The purpose of this study was to determine whether different levels of pain would respond similarly to analgesia. We compared the analgesic response to ibuprofen in subjects with moderate versus severe baseline pain in clinical trials using the third molar post-extraction dental pain model. We performed a pooled raw data analysis of 517 subjects included in the ibuprofen treatment arm of 11 similar studies submitted to the Food and Drug Administration. The inclusion and exclusion criteria were similar in all studies. All studies used the same metrics and recorded pain at the same times. As expected, the well established analgesic effect of ibuprofen was confirmed. More intense baseline pain was initially associated with a larger decrease and greater fractional decreasing in pain intensity after medication. A larger percentage of those with milder baseline pain obtained relief compared with those with severe baseline pain. Reduction in pain intensity occurred mainly in the first 2 h. At later time points, the association of baseline conditions with a reduction in pain level diminished. We conclude that the intensity of initial pain is not correlated with the need for larger doses of analgesic., Implications: A person taking an analgesic wants to know when and how well it will work. People with moderate pain are more likely to get relief, whereas those with severe pain who get relief will get relatively more relief. Most relief of acute pain occurs within less than 2 h. These data indicate that most people with intense initial pain do not require larger doses of analgesics.

The preparation and crystal structure of the title compound, C(20)H(25)NO(2), are described. The N atom substituent of the nitrone function adopts a conformation which minimizes the 1,3-allylic strain.

New dissymmetric tertiary amines (N(3)SR) with varying N/S donor sets have been synthesized to provide mono- and dinuclear complexes. Acetate ions are used to complete the octahedral coordination sphere around nickel(II) atom(s). The facile conversion of mononuclear to dinuclear systems can be controlled to produce either mono- or dinuclear complexes from the same ligand. The dinuclear complex a(BPh(4))(2) ([Ni(2)(N(3)SSN(3))(OAc)(2)](BPh(4))(2)) has been characterized in the solid state by X-ray diffraction techniques as solvate: a(BPh(4))(2).(1/2)[5(CH(3)OH).(CH(3)CN).(CH(3)CH(2)OH)]. The two Ni atoms are six-coordinated and bridged by a disulfide group and two bidentate acetates. Magnetic susceptibility reveals a weak ferromagnetic exchange interaction between the two Ni atoms with J = 2.5(7) cm(-1). UV-vis studies suggest that the six-coordinated structure persists in solution. The (1)H NMR spectrum of a(BPh(4))(2) exhibits sharp significantly hyperfine shifted ligand signals. A complete assignment of resonances is accomplished by a combination of methods: 2D-COSY experiments, selective chemical substitution, and analysis of proton relaxation data. Proton isotropic hyperfine shifts are shown to originate mainly from contact interactions and to intrinsically contain a small J-magnetic coupling and/or zero-field splitting contribution. A temperature dependence study of longitudinal relaxation times indicates that a very unusual paramagnetic Curie dipolar mechanism is the dominant relaxation pathway in these weakly ferromagnetically spin-coupled dinickel(II) centers. The mononuclear nickel(II) analogue exhibits extremely broader (1)H NMR signals and only partial analysis could be performed. These data are consistent with a shortening of electronic relaxation times in homodinuclear compounds with respect to the corresponding mononuclear species.

Background: It is generally accepted that males and females respond differently to painful conditions. With few exceptions, according to the published literature, females demonstrate a lower pain threshold and a lower tolerance of painful stimuli. There is some support in the literature that females experience greater analgesic efficacy than do males after the administration of narcotic analgesics. We compared the analgesic response of females and males to ibuprofen in a post-third-molar extraction dental pain model., Methods: We performed a meta-analysis of 314 subjects included in the ibuprofen treatment arm of 7 double-blind, post-third-molar extraction dental pain (moderate to severe) studies, which were submitted to the agency electronically. The inclusion and exclusion criteria were practically identical in all studies. Pain relief and pain intensity measurements used the same metrics in all studies and were recorded just before and at least at 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0, and 6. 0 hours after drug administration., Results: The study included 195 female subjects and 119 male subjects (mean age, 21 years). Other than requiring dental extractions, the subjects were all healthy. Postoperative baseline pain was greater in females than in males to a statistically significant degree (P =.006). Both pain intensity and pain relief scores demonstrated the well-established analgesic effect of ibuprofen in the pooled data set as well as in all the individual studies. Moreover, the mean pain intensity and pain relief scores over time for the female and male treatment groups were not noticeably different at any time point after drug administration, with no imputation for missing values. Analysis of the data using the "baseline observation carried-forward" technique for remedicated subjects (the technique recommended by the Food and Drug Administration for efficacy analysis of acute analgesic medications) produced the same results, which were confirmed by analysis of variance and t tests at each time point of the study., Conclusions: Our results demonstrated no sex effect on the analgesic response to ibuprofen. These results were obtained under the post-third-molar extraction setting, in which the least possible confounding factors are present. To fully establish the generality of this phenomenon, studies should be carried out in other pain models and using analgesic medications with different mechanisms of action. Arch Intern Med. 2000;160:3424-3428.