Vaccination traditionally has targeted infectious agents and thus has not heretofore been used to prevent neurodegenerative illness. However, amyloid β (Aβ) or tau, which can act like infectious proteins, or prions, might induce Alzheimer's disease (AD). Furthermore, evidence suggests that traditional infectious agents, including certain viruses and bacteria, may trigger AD. It is therefore worth exploring whether removing such targets could prevent AD. Although failing to treat AD patients who already display cognitive impairment, Aβ monoclonal antibodies are being tested in pre-symptomatic, at-risk individuals to prevent dementia. These antibodies might become the first AD therapeutics. However, their high cost will keep them out of the arms of the vast majority of patients, who increasingly live in developing countries. Because vaccines produce antibodies internally at much lower cost, vaccination might be the most promising approach to reducing the global burden of dementia.

Objective: To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program. Methods: Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals. Results: A total of 56 participants were allocated to the experimental group [Formula: see text] and control group [Formula: see text]. There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain. Conclusion: The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.

No abstract

Objectives: To study the factors associated with withdrawal of the and tumor necrosis factor alpha (anti-TNFa) biologics in the treatment of rheumatic diseases.Method: Data from the Hong Kong Biologics Registry were retrieved. The cumulative rates of withdrawal of different biological agents were studied by Kaplan-Meier plot and the incidence of serious adverse events (SAEs) was calculated. Factors associated with the withdrawal of the anti-TNFa agents were studied by Cox regression.Results: Between 2005 and 2013, 2059 courses of biologics were used in 1345 patients. After 3454 patient-years, 1171 (57%) courses were terminated because of clinical inefficacy (38.1%), SAEs (22.3%) and financial reasons (15.9%). The most frequent SAEs (per 100-patient-years) were allergy (2.90), serious infections (1.34), tuberculosis (0.93) and infusion/injection site reaction (0.75). Among the anti-TNFa agents, the cumulative probability of drug withdrawal for either inefficacy or SAEs in 5 years was highest with infliximab (IFX) (64.5%), followed by etanercept (ETN) (44.2%) and adalimumab (ADA) (36.9%). The incidence of serious infections and tuberculosis (per 100 patient-years) for IFX, ETN and ADA users was 1.99, 0.85 and 0.63; and 1.68, 0.43 and 0.85, respectively. Infusion/injection site reaction was highest with IFX (1.38/100 patient-years). Cox regression revealed increasing age, female sex, not having a diagnosis of spondyloarthritis (SpA) and IFX use were significantly associated with drug withdrawal for either inefficacy or SAEs. Rheumatoid arthritis (RA) had the highest hazard ratio for drug withdrawal but SpA was favorable for drug retention, after adjustment for age, sex, disease duration and the choice of anti-TNFa agents.Conclusions: In our registry, the retention rate of the anti-TNFa agents was lowest but the incidence of tuberculosis, serious infections and infusion reaction was highest with IFX. Older female patients with RA and the use of IFX were independently associated with drug withdrawal.

Objectives To study the retention rate of the anti-TNF biologics in the treatment of rheumatic diseases and the associated factors for drug withdrawal Methods The Hong Kong Biologics Registry was established in 2005. Data on the use of biological agents for the treatment of rheumatological disorders in 14 public hospitals were collected prospectively. Efficacy data, serious adverse events (SAEs), withdrawal of biologics and reasons for withdrawal were collected at regular time intervals. This study focused on the retention rate of the anti-TNF biologics, which was studied by the Kaplan-Meier method. Factors associated with drug withdrawal were studied by the Cox proportional hazard models. Results From December 2005 to September 2011, 864 courses of biological agents in 671 patients were reported to our Registry. 59 courses of treatment that involved the non-TNF biologics were excluded. There were 348 women and 323 men. The underlying rheumatic diseases were: rheumatoid arthritis (RA) (N=305, 46%), spondyloarthropathy (SpA) (N=274,41%), psoriatic arthritis (PSA) (N=83,12%) and others (N=9,1%). The choice of the anti-TNF biologics was: infliximab (IFX) (N=439,55%), etanercept (ETN) (N=274,34%) and adalimumab (ADA) (N=92,11%). The dosages of the biologics were: IFX (intravenous;3-5mg/kg for RA, 5mg/kg for SpA/PSA), ETN (subcutaneous; 50mg/week) and ADA (subcutaneous; 40mg/2 weeks). The mean duration of administration was 25±18 months. 358 courses of anti-TNF agents were abbreviated because of the following reasons: 106 (13%) lack/loss of efficacy (primary or secondary failure); 99 (12%) SAEs; 74 (9%) financial reasons; and 79 (10%) other/unspecified reasons. The cumulative drug withdrawal rate (due to either lack/loss of efficacy/AEs) at 12, 24 and 36 months was 24%, 33% and 38% for IFX, and 16%, 19% and 22% for ETN, respectively (log rank test;p<0.001). When drug withdrawal was broken down into that due to loss of efficacy and AEs, data remained in favor of ETN to IFX. The commonest reasons for drug withdrawal because of adverse events were: infusion/injection site reactions (3.4%) and tuberculous infection (3.1%). Among the 21 patients who developed tuberculosis, 19 patients were IFX users whereas only 2 were ETN users. Regarding the underlying rheumatic diseases, RA patients had lower drug retention rate than SpA or PSA patients but the difference did not reach statistical significance (log rank test;p=0.07 between RA and AS). Cox regression analysis revealed that the anti-TNF agent used (IFX versus ETN/ADA; HR1.91[1.38-1.63];p<0.001) and the female sex (HR 1.78[1.07-2.95];p=0.03) was independent predictors for drug withdrawal due to inefficacy after adjustment for age, disease duration and underlying diagnosis (RA vs non-RA). In another Cox regression model with serious adverse events being the reason for drug withdrawal, only the choice of drug itself (IFX versus ETN/ADA; HR1.94[1.23-3.06]; p=0.005) was significantly associated. Conclusions There exists a difference among the anti-TNF biologics for drug rete...

This study aimed to validate an array-based inertial measurement unit to measure cricket fast bowling kinematics as a first step in assessing feasibility for tele-sport-and-exercise medicine. We concurrently captured shoulder girdle relative to the pelvis, trunk lateral flexion, and knee flexion angles at front foot contact of eight cricket medium-fast bowlers using inertial measurement unit and optical motion capture. We used one sample t-tests and 95% limits of agreement (LOA) to determine the mean difference between the two systems and Smallest Worth-while Change statistic to determine whether any differences were meaningful. A statistically significant (p < 0.001) but small mean difference of −4.7° ± 8.6° (95% Confidence Interval (CI) [−3.1° to −6.4°], LOA [−22.2 to 12.7], SWC 3.9°) in shoulder girdle relative to the pelvis angle was found between the systems. There were no statistically significant differences between the two systems in trunk lateral flexion and knee flexion with the mean differences being 0.1° ± 10.8° (95% CI [−1.9° to 2.2°], LOA [−22.5 to 22.7], SWC 1.2°) and 1.6° ± 10.1° (95% CI [−0.2° to 3.3°], LOA [−19.2 to 22.3], SWC 1.9°) respectively. The inertial measurement unit-based system tested allows for accurate measurement of specific cricket fast bowling kinematics and could be used in determining injury risk in the context of tele-sport-and-exercise-medicine.

No abstract

No abstract