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OBJECTIVE: To measure resting energy expenditure (REE) in a group of people with postacute paraplegia, quantify the impact of asymptomatic bacteriuria and pressure sore(s) on patients' metabolic rate, and estimate the adequacy of patients' nutritional intakes to preserve patients' protein levels. MATERIAL AND METHODS: Ten males with post-acute paraplegia aged 42.1+/-18.7 years. We evaluated: height, body mass index (BMI), resting energy expenditure (REE), total daily calorie requirement (E), 24-h urine creatinine excretion (Cru), creatinine index (CI), and nitrogen balance (NB). RESULTS: Subjects with paraplegia showed high erythrocyte sedimentation rates. As a group, they had normal resting calorie consumption when REE was normalized for unit of urine creatinine (REE/Cru), it was higher in patients than in controls. Six of the 10 patients had a low calorie intake: of these only three had a negative nitrogen balance. CONCLUSION: In conclusion, the resting energy expenditure of the subjects with significant bacteriuria and pressure sore(s) of 23.7 kcal/kg/day suggests that a large portion of patients may have an inadequate calorie protein intake to preserve their nutritional status. The clinical significance of this study is that 28.5 kcal/kg/day may be the lower calorie threshold to meet the metabolic demands of people with apyretic paraplegia with bacteriuria and pressure sore(s). [ABSTRACT FROM AUTHOR]

Background: This retrospective study had two main aims: (1) to document possible correlations between plasma Amino Acids (AAs) and circulating Albumin (Alb) and Haemoglobin (Hb); and (2) to identify which AAs were predictors of Alb and Hb., Methods: The study considered 125 stroke subjects (ST) (61.6% males; 65.6 +/- 14.9 years) who met the eligibility criteria (absence of co morbidities associated with altered plasma AAs and presence of plasma AAs determined after overnight fasting). Fifteen matched healthy subjects with measured plasma AAs served as controls., Results: The best correlations of Alb were with tryptophan (Trp) and histidine (His) (r = + 0.53; p < 0.0001), and those of Hb were with histidine (r = +0.47) and Essential AAs (r = +0.47) (both p<0.0001). In multivariate analysis, Trp (p< 0.0001) and His (p = 0.01) were shown to be the best positive predictors of Alb, whereas glutamine (p = 0.006) was the best positive predictor of Hb., Conclusions: The study shows that the majority of plasma AAs were positively correlated with Alb and Hb. The best predictors of circulating Alb and Hb were the levels of tryptophan and glutamine, respectively., Competing Interests: The author Roberto Aquilani is a scientific consultant at Professional Dietetics (Milano, Italy). This company had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. The other authors declare no conflict of interest.

Background: Systemic inflammation and its impact on rehabilitation for patients with non-traumatic haemorrhagic injury (HBI) sequelae has not yet been adequately documented., Objective and Methods: We therefore considered 31 patients with HBI, to determine the serum levels of inflammatory markers (C-Reactive Protein, CRP and or interleukine-6, IL-6) to establish their impact on functional status (Functional Independence Measure, FIM: 18 indicating the worst performance and 126, a normal score)., Results: The results showed an inflammation prevalence (CRP >0.5 mg/dl and/or IL 6 >7 pg/ml) of 74.2% at admission to Rehab. FIM reduction was more pronounced in inflamed compared to non-inflamed subjects (p <  0.05) and significantly correlated with blood variables sensitive to inflammation, such as alpha 1 globulin (r = - 0.565) and neutrophil/ lymphocyte ratio (r = - 0.52), CRP (r = - 0.365). At discharge from Rehab, the inflammation rate diminished. Inflamed patients showed similar gains in FIM score as their controls. In the entire population, the FIM gain was significantly associated with a gain in serum albumin, only (r = +0.56)., Conclusions: We conclude that systemic inflammation is prevalent in HBI patients and contributes to reduce patient functional status. However, during the Rehab stage, inflammation does not hinder the improvement rate of functional capacity.

Diagnostic accuracy and reliable estimation of clinical evolution are challenging issues in the management of patients with disorders of consciousness (DoC). Longitudinal systematic investigations conducted in large cohorts of patients with DoC could make it possible to identify reliable diagnostic and prognostic markers. On the basis of this consideration, we devised a multicentre prospective registry for patients with DoC admitted to ten intensive rehabilitation units. The registry collects homogeneous and detailed data on patients' demographic and clinical features, neurophysiological and neuroimaging findings, and medical and surgical complications. Here we present the rationale and the design of the registry and the preliminary results obtained in 53 patients with DoC (vegetative state or minimally conscious state) enrolled during the first seven months of the study. Data at 6-month post-injury follow-up were available for 46 of them. This registry could be an important tool for collecting high-quality data through the application of rigorous methods, and it could be used in the routine management of patients with DoC admitted to rehabilitation settings.

Background: To investigate whether supplementation with oral essential amino acids (EAAs) may reduce the occurrence of nosocomial infection among patients with brain injury (BI: stroke, trauma, anoxic coma)., Methods: Patients (n = 125; 77 men, 48 women; mean age 63 ± 15 years) with stroke (68.8%), subarachnoid hemorrhage (17.6%), traumatic BI (7.2%), and anoxic BI (6.4%) 88 ± 15 days after the index event. Patients were randomly assigned to 2 months of oral EAAs (n = 63; 8 g/d) or placebo (n = 62)., Results: Over the first month of rehabilitation, there were 60 infections in the whole population of 125 patients (48%); however, the rate was 23.2% lower in the EAA group (23 episodes/63 patients; 36.5%) than in the placebo group (37 episodes/62 patients; 59.7%) (P < .01). The types of infection were similarly distributed between the 2 groups. Serum levels of prealbumin <20 mg/dL and C-reactive protein (CRP) >0.3 mg/dL were the best predictors of future infection (prealbumin: odds ratio [OR] = 4.17, confidence interval [CI] 1.84-9.45, P < .001; CRP: OR = 3.8, CI 1.71-8.44, P < .001)., Conclusion: Supplementary EAAs may reduce the occurrence of nosocomial infections in rehabilitation patients with BI. Prealbumin and CRP are the best predictors of future infections.

Unlabelled: Approximately fifty percent of stroke survivors have neurological deficits. The evaluation of reaction times permits a study of psychomotor performance, which could be very important for a good rehabilitation outcome., Aim: The aim of the study was the evaluation of visual reaction times in a group of patients with cerebrovascular lesions, during inpatient hospitalisation in a rehabilitation centre., Materials and Methods: 46 right-handed patients (34M, 12F) with unilateral cerebrovascular lesion, confirmed by CT or MRI, were enrolled in the study. In each patients visual Simple Reaction Times (SRT) and Multiple Choice Reaction Times (MCRT) were studied. The patients were asked to react by using the hand ipsilateral to the side of the cerebral lesion. Functional impairment of walking, upper limb and hand were measured by a tailored clinical scale with score ranging from 1 to 12. Depression was measured by a modified version of Hamilton scale, tailored for this kind of patient., Results: 13 of 46 patients (28.2%) showed a pathologic reaction time. There was a lack of correlation between reaction times and age, aphasia, lesion size, time from stroke, functional impairment. Patients with hemorrhagic lesions had significantly lower SRT and MCRT. The subgroup of patients with pathologic reaction times were significantly more depressed than patients with normal reaction times., Conclusion: Judging from the present set of results: a) patients with hemorrhagic lesions have lower reaction times; b) the prolongation of reaction times and post-stroke depression appear to be related in stroke patients. This relationship seems to suggest that post stroke depression can negatively affect functional recovery also by means of an impairment of psychomotor performance.

Purpose: We assessed whether voiding dynamics differ in patients with infravesical obstruction from benign prostatic hyperplasia between those with detrusor instability and those with stable bladders., Materials and Methods: A total of 50 such patients with (25) and without (25) detrusor instability was investigated urodynamically by cystometry and pressure-flow study., Results: In the unstable group there was greater obstruction (as assessed by the linear passive urethral resistance relation pressure-flow nomogram) but the detrusor expended less energy (p = 0.001) for voiding the unit volume (54.4 +/- 22.8 mJ./ml versus 74.4 +/- 31.8 mJ./ml. in the stable series). Spared energy was converted into more powerful micturition contractions and more efficient voiding, with a mean maximum contraction power and mean fraction of bladder volume voided of 17.9 +/- 4.9 microW./mm.2 and 93 +/- 11%, respectively, in the unstable population versus 12.7 +/- 2.1 microW./mm.2 (p < 0.001) and 79 +/- 13% (p < 0.001) in the stable subjects., Conclusions: Detrusor instability possibly works within physiological limits as an energy-saving device, preventing voiding efficiency in patients with prostate disease from decreasing too much with increasing obstruction.

In the present study the authors wanted to transfer rigorous methods of study, already in use in other sectors (sports, medicine, isokinetic work, etc.) of the validity of interventions made and their effectiveness, into an "emerging" field, that of perineal rehabilitation. 15 female patients, aged between 35 and 45, affected by stress incontinence underwent a baseline clinico-instrumental evaluation of the perineal floor including a computerized test of endurance. The patients then embarked upon a standardized rehabilitative perineal training lasting a month and at the end underwent an identical evaluation as that performed at the outset. Statistical analysis of the results obtained showed an objective improvement in the parameters considered (endovaginal pressure and its variations during a series of intermittent static contractions) quantitatively supporting clinical evidence.

The peripheral factor (PF), i.e. the ratio: artero-venous oxygen extraction to total peripheral resistences, has been studied in a total of 8 professional basket players under controlled work-load conditions. The results obtained by continuous monitoring heart rate, oxygen consumption, pulmonary ventilation, arterial blood pressure etc, have shown that from 0 to 150 watt work-load, the PF increases linearly showing a slope of 83 degrees, whereas from 150 to 200 watt the pendence reduces up to 45 degrees. The absolute value of PF from a resting value of 3.83 mlo2 X min-1 X mmHg-1 increases up to 21,64 (at 150 watt) and to a maximum of 23.45 mlo2 X min-1 X mmHg-1 at 200 watt. The slope of the first range of load (83 degrees) is quite similar to what previously observed in endurance athletes (cyclists) whereas the 45 degrees angular coefficient indicates that the increased energy demand in basket-players can be obtained only with a large cardiac load.