The probiotics use in VLBW infants within the US is increasing, but is still limited. There was no evidence for safety or efficacy of 90% of the probiotics currently used in US NICUs, and therefore, caution is warranted.

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Background Somatosensory deficits are prevalent after stroke, but effective interventions are limited. Brain stimulation of the contralesional primary somatosensory cortex (S1) is a promising adjunct to peripherally administered rehabilitation therapies. Objective To assess short-term effects of repetitive transcranial magnetic stimulation (rTMS) targeting contralesional (S1) of the upper extremity. Methods Using a single-session randomized crossover design, stroke survivors with upper extremity somatosensory loss participated in 3 rTMS treatments targeting contralesional S1: Sham, 5 Hz, and 1 Hz. rTMS was delivered concurrently with peripheral of sensory electrical stimulation and vibration of the affected hand. Outcomes included 2-point discrimination (2PD), proprioception, vibration perception threshold, monofilament threshold (size), and somatosensory evoked potential (SEP). Measures were collected before, immediately after treatment, and 1 hour after treatment. Mixed models were fit to analyze the effects of the 3 interventions. Results Subjects were 59.8 ± 8.1 years old and 45 ± 39 months poststroke. There was improvement in 2PD after 5-Hz rTMS for the stroke-affected ( F(2, 76.163) = 3.5, P = .035) and unaffected arm ( F(2, 192.786) = 10.6, P < .0001). Peak-to-peak SEP amplitudes were greater after 5-Hz rTMS for N33-P45 ( F(2, 133.027) = 3.518, P = .032) and N45-P60 ( F(2, 67.353) = 3.212, P = .047). Latencies shortened after 5-Hz rTMS for N20 ( F(2, 69.64) = 3.37, P = .04), N60 ( F(2, 47.343) = 4.375, P = .018), and P100 ( F(2, 37.608) = 3.537, P = .039) peaks. There were no differences between changes immediately after the intervention and an hour later. Conclusions Short-term application of facilitatory high-frequency rTMS (5Hz) to contralesional S1 combined with peripheral somatosensory stimulation may promote somatosensory function. This intervention may serve as a useful adjunct in somatosensory rehabilitation after stroke.

To evaluate the need for congenital rubella syndrome prevention in our national health programme we aimed to determine the rate of anti-rubella positivity in umbilical cord blood samples 8 years after measlesrubella mass vaccination in the Islamic Republic of Iran. In a cross-sectional study we tested umbilical cord blood samples for anti-rubella IgG and IgM by ELISA in 154 deliveries at a university hospital in Tehran. Overall 72.7% of umbilical cord blood samples were positive for anti-rubella IgG and 27.3% were negative. All of the samples were negative for anti-rubella IgM. In the samples with a history of mothers' rubella vaccination, only 87.5% were positive for anti-rubella IgG. The results suggest the need for another mass vaccination for rubella in women of child-bearing age and continuation of routine vaccination of infants, plus consideration of obligatory anti-rubella IgG testing before pregnancy in women who were not vaccinated and vaccination of women before marriage. RÉSUMÉ Pour évaluer la nécessité d'intégrer la prévention du syndrome de rubéole congénitale dans notre programme de santé national, nous avons tenté de déterminer le taux de positivité aux anticorps antirubéoleux dans des échantillons de sang de cordon ombilical huit ans après la campagne de vaccination de masse contre la rougeole et la rubéole en

Purpose: Sensory deficits are prevalent after stroke but effective interventions are limited. Non-invasive brain stimulation is a promising adjunct to peripherally administered rehabilitation therapies. However, the utility of brain stimulation in sensory re-education after stroke has not been tested. The purpose of this study was to assess immediate response to repetitive Transcranial Magnetic Stimulation (rTMS) of the contralesional primary sensory cortex (S1). Methods: Stroke survivors (>6 mo post; n=16) with arm sensory deficits participated in 3 different rTMS treatments targeting contralesional S1 as follows: 1) Sham, 2) 5 Hz and 3) 1 Hz. rTMS was paired with peripherally directed modalities (electrical stimulation via mesh glove followed by hand vibration). rTMS paradigms were administered in random order 1 week apart. Outcomes included 2-point discrimination, vibration, monofilament discrimination and proprioception. Measures were collected before and 1 hour after treatment and responses were calculated as post minus pre for each session. Data did not appear to be normally distributed, nor were responses correlated between the 3 treatments. Kruskal-Wallis tests were employed. Results: Subjects were 59.8±8.3 years old, 43±38 months after stroke, 88% were male and 59% had subcortical stroke. Baseline sensory impairment for the stroke Affected (A) and Unaffected (U) arms were as follows: 2-point discrimination threshold 12.47±4.73mm (A) and 2.86±1.01mm (U), monofilament 4.98±1.69mm (A) and 3.55±0.55mm (U), proprioception % accuracy at index 71.67±24.6%(A) and 99.37±1.81% (U), vibration amplitude threshold in relative units 9.7±8.6(A) and 4.75±1.8(U). There was an improvement in 2-point discrimination after 5 Hz rTMS in the affected arm; a reduced threshold of 1.68±3.5mm following 5Hz intervention vs reduction of 0.333±1.18mm after 1 Hz and increase of 0.13±2.06mm after sham (p=0.009). The unaffected arm also had improvement in 2-point discrimination of 0.38±0.8mm following 5Hz rTMS compared with increased threshold after both 1Hz (0.6±0.73mm) and sham (0.2±0.77mm) (p=0.009). Conclusion: High frequency rTMS targeting contralesional S1 cortex is a potential adjunct intervention for sensory re-education after stroke.

Purpose: Anatomical localization of brain networks controlling post-stroke spasticity are not fully understood. The purpose of this study was to determine the relationship between the integrity of white matter tracts and severity of spasticity and how this relationship changes with mitigation of spasticity in response to motor learning therapy. Methods: Eleven stroke survivors (>6 months post-stroke) with arm sensorimotor deficits had 12-week (5 d/week, 5 hr/day) motor learning therapy. Outcome measures included modified Ashworth Scale (mAS), Fugl-Meyer Upper limb (FM) and Diffusion Tensor Imaging (DTI). mAS was scored for 9 arm muscles and summated. Using Freesurfer software, DTI was analyzed via longitudinal processing stream and white matter tracts were reconstructed according to a global probabilistic tractography algorithm. Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were averaged along the center of the 8 bilateral and 2 interhemispheric white matter tracts. We performed partial Spearman correlation (Bonferonni correction for multiple comparisons) to evaluate the relationship between mAS and DTI measures while controlling for change in Fugl-Meyer. Wilcoxon paired sign rank test was used to compare pre vs post rehab scores for mAS and FM. Results: Subjects were 59±8.3 years old, 46±30 months after stroke and 54% were female. mAS improved from 5.95±3 to 3.95±2.6 (p=0.002, paired sign rank test) and FM improved from 25.9±12.4 to 37.6±13.9 (p=0.00097). At baseline, lower spasticity correlated with higher AD in the ipsilesional cingulum angular bundle (rho=.86; p=0.0007). Greater improvement in spasticity correlated with lower AD in the contralesional uncinate fasciculus (rho=.79;p=0.004) at baseline. Both tracts are part of limbic system. Furthermore, lower spasticity at baseline correlated with lower FA in the contralesional corticospinal tract (rho=.81; p=0.004) at baseline. Conclusion: The results show the complex nature of anatomical localization for spasticity and its mitigation. Structural integrity of the contralesional corticospinal tract as well as bi-hemispheric limbic system tracts may be involved in post-stroke spasticity.