Eric L. Altschuler

Pharmacotherapy of osteoarthritis.

Stitik TP, Altschuler E, Foye PM: Pharmacotherapy of osteoarthritis. Am J Phys Med Rehabil 2006;85(Suppl):S15–S28.

A Ventilator Requirement Index

Bach JR, Goncalves M, Eisenberg M, Ishikawa Y, Altschuler E, Winck JC, Komaroff E: A ventilator requirement index. Am J Phys Med Rehabil 2008;87:285–291. Objective:To determine the efficacy of vital capacity (VC) and a proposed ventilator requirement index (VRI) for justifying ventilator prescription and use for patients with neuromuscular/chest wall diseases (NMD). Design:Prospective observational study in which 319 patients with NMD, including 187 ventilator users, were separated into four groups: (1) asymptomatic, (2) abnormal specific screening factors and/or symptomatic, (3) ventilator use 8–20 hrs/day, and (4) >20 hrs/day of ventilator use. The VRI was defined as 60 × Ti/(Ttot)2 × (Vt/VC) × RR, where Ti = inspiratory time of one breath (secs), Ttot = total time of one breath (secs), Vt = tidal volume (ml) at rest, VC = vital capacity (ml), and RR = respiratory rate. Results:The overall analysis of variance F-tests and post hoc pairwise contrasts were significant (P < 0.001) for differences in the VC and VRI across groups. Thus, VC and VRI are independent predictors of group membership. Satisfying VC or VRI criteria signaled the highest number of patients benefiting from ventilator use. Conclusions:The prescription of one or two ventilators can be justified by both VC and VRI, with the combination being most sensitive.

Designing the objective structured clinical examination to cover all major areas of physical medicine and rehabilitation over 3 yrs.

ABSTRACT The Accreditation Council for Graduate Medical Education requires that training programs comprehensively evaluate residents in the six core Accreditation Council for Graduate Medical Education competencies. One of the ways we do this in our residency is by administering a nine-station Objective Structured Clinical Examination (OSCE) at the end of each year, which evaluates tasks such as history taking, focused physical examination, communication, professionalism, procedural skills, management, prescription writing, and understanding systems-based practice. We have classified our OSCE stations into what we consider key areas in our field and assessed these on a rotating basis over 3 yrs. This results in the assessment of 27 areas over the 3 yrs of residency. Structuring the OSCE as a series of stations over 3 yrs is an efficient method to evaluate residents’ competencies that are required by the Accreditation Council for Graduate Medical Education and certifying boards. An analysis of OSCE scores when compared with American Board of Physical Medicine & Rehabilitation parts 1 and 2 scores and final summative resident evaluation scores reveals that OSCE results correlate with part 1 scores and final evaluation scores but do not show the same strong correlations with part 2 scores. We discuss the way the OSCE can complete other assessment techniques and ways to improve cases in the future.

Indoleamine 2,3-dioxygenase-expressing mature human monocyte-derived dendritic cells expand potent autologous regulatory T cells: consideration of triamterene to treat lupus.

NPC cell lines and tissues. Moreover, through IgA receptor-mediates endocytosis, EBV infection can be detected in NPC cell lines; and EBV-infected NPC cell lines also show increasing production of oncogenes, such as epidermal growth factor receptor (EGFR), tumor growth factor-a (TGF-a) and many cell proliferation-associated genes. As a whole, above these extensive studies, we assume that EBV infection may play a role in the secondary effect during NPC progression, or EBV infection is not as a primary factor of NPC etiopathogenisis.

Did the 1918 flu virus cause the Black Death

[1] Fan SQ, Qin LY, Cai JL, et al. Effect of heparin on production of basic fibroblast growth factor and transforming growth factor-beta1 by human normal skin and hyperplastic scar fibroblasts. J Burn Care Res 2007;28:734–41. [2] Fan SQ, Cai JL, Qin LY, et al. Effect of heparin on production of transforming growth factor (TGF)-beta1 and TGF-beta1 mRNA expression by human normal skin and hyperplastic scar fibroblasts. Ann Plast Surg 2008;60: 299–305. [3] Li XW, Liu JJ, Wu JX, et al. The expression of lefty protein in adult normal skin, human embryonic skin and hyperplastic scar. Zhonghua Shao Shang Za Zhi 2008;24:45–7. Xing Fan Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China

A Review of Lung Transplantation and Its Implications for the Acute Inpatient Rehabilitation Team

Since the late 1980s, lung transplantation has become an option for some individuals (in 2014, 4000 lung transplantations were performed) with end‐stage lung disease aimed to help these individuals restore function and improve survival and quality of life. Individuals living with end‐stage lung disease already are deconditioned, with poor endurance and limited exercise capacity. There are additional post‐transplantation factors that can contribute to poor endurance and decreased exercise capacity. Although pulmonary rehabilitation in the pretransplantation phase is a crucial component for positive functional outcomes after lung transplantation, the incidence of post‐transplantation complications, coupled with the need for immunosuppression, often warrants close monitoring by medical professionals. The acute inpatient rehabilitation unit offers an ideal setting for such patients to receive therapies to improve functional status while allowing for monitoring and medical management with a comprehensive team approach, including both the rehabilitation and the transplantation teams. In this article, we review the medical issues, physiologic changes, common complications after lung transplantation, and potential side effects of immunosuppressant therapy, as well as address rehabilitation specific concerns, outcomes, and goals of the patient undergoing lung transplantation in the acute inpatient rehabilitation unit.

Efficacy of a checklist as part of a physical medicine and rehabilitation clerkship to teach medical students musculoskeletal physical examination skills: a prospective study.

ObjectiveThe aim of this study was to evaluate the efficacy of a checklist as part of a physical medicine clerkship to teach medical students physical examination maneuvers. DesignThis is a prospective study performed on fourth year medical students enrolled in a 2-wk mandatory clerkship of the Department of Physical Medicine and Rehabilitation. At the start and end of the rotation, the participating students were tested by performing 20 physical examination maneuvers on an investigator who was both the standardized patient and the evaluator. At the end of the rotation, the students also completed a survey. Data were analyzed using the Bernoulli trial model, with the percentage of students who performed the maneuver correctly on the pretest as the a priori probability. A full Bonferroni correction was applied. ResultsThe authors enrolled 141 of the 176 fourth year medical students; 121 completed testing. At prerotation, approximately 35% of the physical examination maneuvers were performed correctly; at postrotation, 82%. For 19 of 20 maneuvers, the improvement was statistically significant at P < 0.01. The survey results indicated that the students felt that they had limited exposure to musculoskeletal examination skills at prerotation, that this rotation helped them achieve competency in performing the maneuvers, and that this would improve their future patient care irrespective of field of choice. ConclusionsConsidering the high prevalence of musculoskeletal disorders and the anticipated rise in the future, the authors strongly recommend teaching musculoskeletal physical examination maneuvers in medical school, which can be accomplished via a mandatory physical medicine and rehabilitation rotation. The authors conclude that checklists as part of this rotation can effectively help in teaching physical examination skills to medical students.

Rehabilitation of the Pontine Ataxia-Dysmetria Syndrome

We present a case of a patient with significant ataxia and dysmetria following a lacunar pontine infarction and review the literature on this uncommon syndrome. The patient had an excellent clinical course with near resolution of symptoms and signs in less than 3 weeks. We illustrate the patients ataxia and dysmetria with videos and also use the videos to demonstrate and characterize the features of the dysmetria. Interestingly, the characteristics of the dysmetria appear to be different from those seen in patients with dysmetria arising from a cerebellar or thalamic lesion. We discuss the likely neurophysiologic mechanisms responsible for the condition and recovery. Simple noninvasive study of patients with ataxia and dysmetria secondary to a pontine lacunar infarct may be most helpful in elucidating the contribution of pontocerebellar fibers to motor control.

Pure apraxia of speech due to infarct in premotor cortex

Apraxia of speech (AOS) is now recognized as an articulation disorder distinct from dysarthria and aphasia. Various lesions have been associated with AOS in studies that are limited in precise localization due to variability in size and type of pathology. We present a case of pure AOS in setting of an acute stroke to localize more precisely than ever before the brain area responsible for AOS, dorsal premotor cortex (dPMC). The dPMC is in unique position to plan and coordinate speech production by virtue of its connection with nearby motor cortex harboring corticobulbar tract, supplementary motor area, inferior frontal operculum, and temporo-parietal area via the dorsal stream of dual-stream model of speech processing. The role of dPMC is further supported as part of dorsal stream in the dual-stream model of speech processing as well as controller in the hierarchical state feedback control model.

A phonology-free mobile communication app

Abstract Purpose: Aphasia – loss of comprehension or expression of language – is a devastating functional sequela of stroke. There are as yet no effective methods for rehabilitation of aphasia. An assistive device that allows aphasia patients to communicate and interact at speeds approaching real time is urgently needed. Methods: Behavioral and linguistic studies of aphasia patients show that they retain normal thinking processes and most aspects of language. They lack only phonology: the ability to translate (input) and/or output sounds (or written words) such as “ta-ble” into the image of a four-legged object with a top at which one works or eats. Results: We have made a phonology-free communication mobile app that may be useful for patients with aphasia and other communication disorders. Particular innovations of our app include calling Google Images as a “subroutine” to allow a near-infinite number of choices (e.g. food or clothing items) for patients without having to make countless images, and by the use of animation for words, phrases or concepts that cannot be represented by a single image. We have tested our app successfully in one patient. Conclusions: The app may be of great benefit to patients with aphasia and other communication disorders. Implications for Rehabilitation We have made a phonology-free mobile communication app. This app may facilitate communication for patients with aphasia and other communication disorders.