Scientific publications

Inpatient trunk exercises after recent stroke: an update meta-analysis of randomized controlled trials.


Daniele Costa Borges Souza, Matheus de Sales Santos, Nildo Manoel da Silva Ribeiro, Igor Lima Maldonado

DOI http://doi.org/10.3233/NRE-182585
Scientific Field Life & Health Sciences
Fellow Prof. Igor Lima Maldonado
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INTRODUCTION:Although the role of trunk exercises in the chronic phase of stroke is acknowledged, the addition of specific inpatient training in the subacute stage is a matter of debate and varies among centers. Recent new evidence suggests the question should be revisited. OBJECTIVE:To assess the impact of the addition of specific trunk training to inpatient rehabilitation protocols after a recent stroke. METHODS:A systematic review was performed assessing the impact of inpatient trunk training. The search was performed in LILACS, SciELO, PEDro, Cochrane, and NCBI PubMed databases for clinical trials published up to December 31st, 2017. The initial bibliographic research identified 3202 articles. After analyzing the titles, 19 abstracts were selected for detailed analysis. After application of the eligibility criteria, the final selection included nine studies. Outcome measurements from the same evaluation instruments were submitted to a meta-analysis to improve homogeneity (7 studies). RESULTS:All patients in the included studies were recruited less than three months after a stroke. Seven studies assessed trunk control using the Trunk Impairment Scale (TIS). There was a significant improvement in trunk control with a pooled increase in TIS score of 3.3 points from the baseline (CI95:2.54–4.06, p 


Stereoscopic images from computed tomography angiograms


François Lechanoine, Mykyta Smirnov, Giulia Armani Franceschi, Pedro Carneiro, Philippe Cottier, Christophe Destrieux, Igor Lima Maldonado

DOI https://doi.org/10.1016/j.wneu.2019.04.257
Scientific Field Life & Health Sciences
Fellow Prof. Igor Lima Maldonado
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Objective
To present an adaptation of the anaglyph photography technique to be used with radiological images from computed tomography angiograms, enabling stereoscopic visualization of a patient's individual abnormal vascular anatomy for teaching, case discussion, or surgical planning purposes.

Methods
Traditional anaglyph procedures with actual objects yield 2 independent photographs, simulating the image perceived by each eye. Production of anaglyphs from angiograms involve 3 basic procedures: volume rendering, image capture, and image fusion. Volume renderings were reconstructed using a free, open-source DICOM (Digital Imaging and Communications in Medicine) reader. Subsequently, the virtual object was positioned to mimic the operator's angle of view, and different perspectives of the reconstructed volume could be obtained through exclusively horizontal rotation. The 2 images were then fused after their color composition was modified so that each eye would perceive only 1 image when using anaglyph glasses.

Results
Forty-three angiograms were reviewed for the purpose of this study and a total of 6 examinations were selected for illustration of the technique. Stereoscopic display was possible for all of them and in the 3 types of support tested: computer monitor, tablet, and smartphone screens.

Conclusions
Anaglyph display of computed tomography angiograms is an effective and low-cost alternative for the stereoscopic visualization of a patient's individual intracranial vascular anatomy.


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Aim of the study: To assess a program combining virtual reality (VR) games and proprioceptive neuromuscular facilitation (PNF), and to compare it to the standalone techniques in stroke survivors.
Methods: A randomized controlled clinical trial. Forty-eight participants were recruited in the outpatient clinic of a University Hospital in Salvador, Brazil. They were randomly assigned to three groups (n=16 each): PNF, VR, and PNF/VR. Participants attended twice-weekly fifty-minute sessions over a two-month period. The PNF/VR group performed both PNF and virtual reality exercises employing Nintendo Wii electronic games. Motor performance was assessed before and immediately after the treatment using the Fugl-Meyer Assessment scale.
Results: Improvement in the mean scores was observed after treatment independent of the allocation group with significant intra-group changes: 14.5, 10.5, and 10.4 for PNF, VR and PNF/VR, respectively. Score changes were also observed in the analyses of specific sections as follows: (1) A significant improvement in the passive movement and pain score was observed in the PNF and PNF/VR groups. (2) The same was observed for the motor function of the upper limb in all groups, for the motor function of the lower limb in the VR group and for balance in the PNF and PNF/VR groups.
Conclusion: The use of a program combining virtual rehabilitation and PNF presented results that were comparable to those obtained with the isolated techniques


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Although the middle longitudinal fasciculus (MdLF) is not part of the insular lobe, it penetrates the temporal operculum, which is manipulated or partially removed during surgical approaches to the insula. We present a comprehensive description of that fascicle and its anatomical relationships with neighboring structures that have been described in previous chapters. It has been hypothesized that MdLF plays a role in attention and language processing; however studies with peroperative subcortical electrostimulation or temporal lobectomies did not demonstrate permanent language deficits following resection of its anterior segment. The MdLF has close relationships to adjacent bundles, such as the arcuate fasciculus and the inferior fronto-occipital fasciculus that are required to be recognized and differentiated for adequate interpretation of tractography images and surgical planning.


Gross Anatomy of the Human Insula


Igor Lima Maldonado, Ilyess Zemmoura, Christophe Destrieux

DOI https://doi.org/10.1007/978-3-319-75468-0_2
Scientific Field Life & Health Sciences
Fellow Prof. Igor Lima Maldonado
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When the lips of the lateral fissure are separated from each other, a new group of sulci and gyri appear. They are arrayed together in the form of an island, which is the reason why the German anatomist, Johann Christian Reil, named them “the insular lobe”. Bordered by the limiting sulci, its general form resembles that of an oblique pyramid with a triangular base and low height. Although some anatomical variation exists, the insula presents a systematizable internal organization and well-defined anatomical relationships with deep and superficial cerebral structures, such as the extreme capsule and the cerebral opercula. In this chapter we review concepts of the insular morphology that are important to the fields of neurosurgery and neuroimaging.


Zoonotic helminth exposure and risk of allergic diseases: A study of two generations in Norway


N. O. Jõgi, C. Svanes , S. P. Siiak , E. Logan, J. W. Holloway, J. Igland, A. Johannessen, M. Levin, F. G. Real , V. Schlunssen, W. G. C. Horsnell , R. J. Bertelsen

DOI https://doi.org/10.1111/cea.13055
Scientific Field Life & Health Sciences
Fellow Dr William Horsnell
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Background: Animal and human studies indicate that definitive host helminth infections may confer protection from allergies. However, zoonotic helminths, such as Toxocara species (spp.), have been associated with increased allergies.

Objective: We describe the prevalence of Toxocara spp. and Ascaris spp. seropositivity and associations with allergic diseases and sensitization, in 2 generations in Bergen, Norway.

Methods: Serum levels of total IgG4, anti-Toxocara spp. IgG4 and Ascaris spp. IgG4 were established by ELISA in 2 cohorts: parents born 1945-1972 (n = 171) and their offspring born 1969-2003 (n = 264). Allergic outcomes and covariates were recorded through interviews and clinical examinations including serum IgEs and skin prick tests.

Results: Anti-Ascaris spp. IgG4 was detected in 29.2% of parents and 10.3% of offspring, and anti-Toxocara spp. IgG4 in 17.5% and 8.0% of parents and offspring, respectively. Among offspring, anti-Toxocara spp. IgG4 was associated with pet keeping before age 15 (OR = 6.15; 95% CI = 1.37-27.5) and increasing BMI (1.16 [1.06-1.25] per kg/m2). Toxocara spp. seropositivity was associated with wheeze (2.97[1.45- 7.76]), hayfever (4.03[1.63-9.95]), eczema (2.89[1.08-7.76]) and cat sensitization (5.65[1.92-16.6]) among offspring, but was not associated with allergic outcomes among parents. Adjustment for childhood or current pet keeping did not
alter associations with allergies. Parental Toxocara spp. seropositivity was associated with increased offspring allergies following a sex-specific pattern.

Conclusions & Clinical Relevance: Zoonotic helminth exposure in Norway was less frequent in offspring than parents; however, Toxocara spp. seropositivity was associated with increased risk of allergic manifestations in the offspring generation, but not among parents. Changes in response to helminth exposure may provide insights into the increase in allergy incidence in affluent countries.


Emergomyces africanus in Soil, South Africa


lan S. Schwartz, Barbra Lerm, J. Claire Hoving, Chris Kenyon, William G. Horsnell, W. Joan Basson, Patricia Otieno-Odhiambo, Nelesh P. Govender, Robert Colebunders, Alfred Botha

DOI https://doi.org/10.3201/eid2402.171351
Scientific Field Life & Health Sciences
Fellow Dr William Horsnell
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We detected Emergomyces africanus, a thermally dimorphic fungus that causes an HIV-associated systemic mycosis, by PCR in 18 (30%) of 60 soil samples from a wide range of habitats in South Africa. Direct and indirect culture techniques were unsuccessful. Experimental intraperitoneal inoculation of conidia induced murine disease.


Disruption of maternal gut microbiota during gestation alters offspring microbiota and immunity


Donald D. Nyangahu, Katie S. Lennard, Bryan P. Brown, Matthew G. Darby, Jerome M. Wendoh, Enock Havyarimana, Peter Smith, James Butcher, Alain Stintzi, Nicola Mulder, William Horsnell, Heather B. Jaspan

DOI https://doi.org/10.1186/s40168-018-0511-7
Scientific Field Life & Health Sciences
Fellow Dr William Horsnell
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Background
Early life microbiota is an important determinant of immune and metabolic development and may have lasting consequences. The maternal gut microbiota during pregnancy or breastfeeding is important for defining infant gut microbiota. We hypothesized that maternal gut microbiota during pregnancy and breastfeeding is a critical determinant of infant immunity. To test this, pregnant BALB/c dams were fed vancomycin for 5 days prior to delivery (gestation; Mg), 14 days postpartum during nursing (Mn), or during gestation and nursing (Mgn), or no vancomycin (Mc). We analyzed adaptive immunity and gut microbiota in dams and pups at various times after delivery.

Results
In addition to direct alterations to maternal gut microbial composition, pup gut microbiota displayed lower α-diversity and distinct community clusters according to timing of maternal vancomycin. Vancomycin was undetectable in maternal and offspring sera, therefore the observed changes in the microbiota of stomach contents (as a proxy for breastmilk) and pup gut signify an indirect mechanism through which maternal intestinal microbiota influences extra-intestinal and neonatal commensal colonization. These effects on microbiota influenced both maternal and offspring immunity. Maternal immunity was altered, as demonstrated by significantly higher levels of both total IgG and IgM in Mgn and Mn breastmilk when compared to Mc. In pups, lymphocyte numbers in the spleens of Pg and Pn were significantly increased compared to Pc. This increase in cellularity was in part attributable to elevated numbers of both CD4+ T cells and B cells, most notable Follicular B cells.

Conclusion
Our results indicate that perturbations to maternal gut microbiota dictate neonatal adaptive immunity.


Elevated IgG Responses in Infants Are Associated With Reduced Prevalence of Mycobacterium tuberculosis Infection


Erin Logan, Angelique Kany Kany Luabeya, Humphrey Mulenga, Dunja Mrdjen, Cynthia Ontong, Adam F. Cunningham, Michele Tameris, Helen McShane, Thomas J. Scriba, William G. C. Horsnell, Mark Hatherill

DOI https://doi.org/10.3389/fimmu.2018.01529
Scientific Field Life & Health Sciences
Fellow Dr William Horsnell
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Background: It is unclear whether antibodies can prevent Mycobacterium tuberculosis (Mtb) infection. In this study, we examined the relationship between total plasma IgG levels, IgG elicited by childhood vaccines and soil-transmitted helminths, and Mtb infection prevalence, defined by positive QuantiFERON (QFT) test.

Methods: We studied 100 Mtb uninfected infants, aged 4–6 months. Ten infants (10%) converted to positive QFT test (QFT+) within 2 years of follow-up for Mtb infection. Antibody responses in plasma samples acquired at baseline and tuberculosis investigation were analyzed by enzyme-linked immunosorbent assay and ImmunoCAP® assay.

Results: QFT− infants displayed a significant increase in total IgG titers when re-tested, compared to IgG titers at baseline, which was not observed in QFT+ infants. Bacille Calmette-Guérin (BCG) vaccine-specific IgG2 and live-attenuated measles vaccine-specific IgG were raised in QFT− infants, and infants who acquired an Mtb infection did not appear to launch a BCG-specific IgG2 response. IgG titers against the endemic helminth Ascaris lumbricoides increased from baseline to QFT re-testing in all infants.

Conclusion: These data show raised IgG associates with a QFT-status. Importantly, this effect was also associated with a trend showing raised IgG titers to BCG and measles vaccine. Our data suggest a possible protective association between raised antibody titers and acquisition of Mtb infection, potentially mediated by exposure to antigens both related and unrelated to Mtb.


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Future HIV vaccines are expected to induce effective Th1 cell-mediated and Env-specific antibody responses that are necessary to offer protective immunity to HIV infection. However, HIV infections are highly prevalent in helminth endemic areas. Helminth infections induce polarised Th2 responses that may impair HIV vaccine-generated Th1 responses. In this study, we tested if Schistosoma mansoni (Sm) infection altered immune responses to SAAVI candidate HIV vaccines (DNA and MVA) and an HIV-1 gp140 Env protein vaccine (gp140) and whether parasite elimination by chemotherapy or the presence of Sm eggs (SmE) in the absence of active infection influenced the immunogenicity of these vaccines. In addition, we evaluated helminth-associated pathology in DNA and MVA vaccination groups. Mice were chronically infected with Sm and vaccinated with DNA+MVA in a prime+boost combination or MVA+gp140 in concurrent combination regimens. Some Sm-infected mice were treated with praziquantel (PZQ) prior to vaccinations. Other mice were inoculated with SmE before receiving vaccinations. Unvaccinated mice without Sm infection or SmE inoculation served as controls. HIV responses were evaluated in the blood and spleen while Smassociated pathology was evaluated in the livers. Sm-infected mice had significantly lower magnitudes of HIV-specific cellular responses after vaccination with DNA+MVA or MVA