Classification of heart failure in population based research: An assessment of six heart failure scores

Several scores based on symptoms and signs have been developed to assess the presence of heart failure. The goal of this study was to compare six heart failure scores in non-hospitalised subjects and to determine their usefulness in population based research. The scores were applied to 54 participants of a population based study. All underwent a complete medical examination, including chest X-ray, electrocardiography and Doppler echocardiography. Using all information available, a cardiologist, unaware of the results of the scores, clinically classified participants as having no, possible or definite heart failure. Sensitivity, specificity, predictive values and receiver operating characteristics were calculated, using the cardiologist's assessment as a gold standard. The cardiologist judged definite or possible heart failure to be present in 17 persons. All scores had a high sensitivity for the detection of definite heart failure, whereas the study of men born in 1913 and Walma's score had the highest sensitivity for the combination of possible and definite heart failure. Gheorgiade's and the Boston score had the highest positive predictive values. In conclusion, five of the six scores we studied are broadly similar in the detection of heart failure. The men born in 1913 score relies heavily on the assessment of dyspnea, resulting in a relatively large number of false positives. Although the scores are useful in detecting manifest heart failure, objective measurements of cardiac function appear necessary to reduce the false positive rate and accurately detect early stages of heart failure.     

Feasibility,acceptability and effects of dance therapy in stroke patients: A systematic review

IntroductionStroke is the leading cause of non-traumatic disability in adults, with balance and gait disturbances representing the main limitations of body functions. Dance therapy (DT) has shown positive effects in older adults and in patients with neurological pathologies. This systematic review aims to examine the feasibility, acceptability and effects of DT in stroke rehabilitation, specifically on functional gains of gait and balance.MethodsA systematic search was carried out for articles published in the MEDLINE, PEDro, Web of Science, Scopus and CINHAL in February 2021 and updated in April 2021. Results: Eight studies were included (2 clinical cases, 5 case series and 1 randomized controlled trial), 7 of them in patients with chronic stroke and only 1 in subacute stroke phase. The most widely used dance modality was tango and ballet, with sessions ranging from 30 to 110 min. DT seems to show positive effects on post-stroke body functions and activities such as gait and balance. Reported dropout rates are inconsistent, no adverse effects were reported, and participant satisfaction was high.ConclusionGiven the heterogeneity and uneven quality of the included studies, strong conclusions cannot be put forward on the effectiveness of DT in post-stroke body function and activities. Nevertheless, DT seems to be safe and acceptable therapy for patients, and no adverse effects have been reported. More studies with a high level of evidence and feasibility are needed to determine the patient profile, the characteristics of the intervention, the participation rate and the role of the rehabilitation professional most likely to generate optimal benefit.     

Classification of normal and pathological tremors using a multidimensional electromagnetic system

A new multidimensional movement analysis system was used to record limb tremor over six degrees-of-freedom, and signal processing techniques were explored to develop a suitable classification method to distinguish between different types of tremor. The specific aims were to investigate the ability of the system to screen for differences between normal subjects and a group of neurological patients, and then to differentiate between three diagnostic groups of patients.

Postural tremor at the hand was recorded in normal subjects (n=24) and patients with essential tremor (n=21), multiple sclerosis (n=17) and parkinsonism (n=19). Data were collected using a 3Space Fastrak^® (Polhemus, Inc.) over six degrees-of-freedom (three translational directions and three rotations). Spectral estimates produced measures of tremor frequency and amplitude. Mathematical models of the data, using autoregressive modelling and K-nearest neighbour classification, produced parameters used to classify, (1) the normal subjects and 24 patients (using the three rotational movements), and (2) the three patient groups (using all six movement directions). Results were given in terms of the probability of each subject belonging to the groups being classified.

Tremor frequency and amplitude showed large overlap between the groups. The screening classification produced high probabilities of correctly classifying normal subjects (>70%) and patients (>70%). The diagnostic classification produced clear differences between the patient groups (60% for essential tremor, 80% for multiple sclerosis and 60% for parkinsonism).

The ability of this assessment technique to distinguish between postural tremor in normal subjects and neurological patients suggests that it could be developed as a screening tool. Classification of tremors between the patients groups, with a high degree of sensitivity, indicates the potential for further development of the system as a diagnostic aid.     

Treatment of angioimmunoblastic lymphadenopathy with dysproteinemia using 2-chlorodeoxyadenosine

 Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) is an atypical lympho-proliferative disorder with borderline features that often constitute a diagnostic challenge for the hematopathologist and a therapeutic dilemma for the treating clinician. Morphologically, the involved lymph nodes in this disorder are characterized by abnormal infilitration by immunoblasts and plasma cells, often in clusters or sheets. Regressed follicles may be seen; these are referred to as "burned out." Neovascularization is prominent, and a background of inflammatory cells is usually present. AILD was originally thought to represent an exaggerated autoimmune response. Because of the short median survival of the patients and the demonstration of T-cell clonality, AILD now is considered an aggressive lymphoma and is recognized as a subset of peripheral T-cell lymphoma by the REAL classification. In this article we present a patient with AILD who achieved durable patrial remission after treatment with one cycle of 2-chlorodeoxyadenosine. Received: 16 March 1994 / Accepted: 8 July 1996     

Supratentorial recurrences of gliomas. Morphological studies in relation to time intervals with astrocytomas

Summary We report 137 recurrent supratentorial astrocytomas. The primary tumours diagnosed on the basis of a grading system with three stages were 72 astrocytomas I and 65 astrocytomas II. In the first group 14% of the recurrences were not changed, 55.5% became astrocytomas II, and 30.5% became glioblastomas. In the second group 55.4% were unchanged, and 44.6% became glioblastomas. The postoperative intervals until reintervention or death were statistically examined. It seems that the recurrence time chiefly depends on the nature of the primary tumour. The transformation of an astrocytoma I to a glioblastoma takes longer than the transformation of an astrocytoma II into a glioblastoma. In about two thirds of all astrocytomas an increase of malignancy is to be expected. From the histological picture it is not possible in an individual case to predict the likelihood or speed of malignant change. With regard to the effect of irradiation the authors conclude that radiotherapy most probably does not produce malignancy.The authors wish to express their gratitude to the founder and organizer of the Institute of Neurosurgery in Budapest, Prof. Dr. L. Zoltán (), for his promotion of these investigations.     

Emergency ventilation using the Combitube in cases of difficult intubation

Summary The esophageal-tracheal Combitube (Sheridan, Argyle, NY) is a new device for emergency intubation, which can be inserted blindly without the use of a laryngoscope. Ventilation is independent of the position of the Combitube in either the esophagus or the trachea, since ventilation is always provided by the tube's double channel. The tracheal channel acts as a conventional endotracheal airway and has an open distal end. The esophageal channel has a blocked distal end, so that together with the inflated distal cuff it acts as an esophageal obturator in cases of esophageal intubation. Perforations at the pharyngeal section direct the airflow to the trachea. At the oropharyngeal section a large elastic balloon is positioned in order to obturate the oral cavity and the nasopharynx. Two patients are described to exemplify the Combitube's clinical use. Both had rapidly enlarging cervical hematomas causing upper airway obstruction and thus requiring immediate intubation. Endotracheal intubation failed because the glottis could not be visualized with a laryngoscope. In both cases the Combitube was applied successfully and adequate ventilation was provided via the Combitube placed esophageally. To better secure each patient's airway, tracheotomy was performed during ventilation without any complications.     

Prediction of survival and recurrence in bladder carcinoma

Summary We have followed a large population of patients receiving radiation treatment for bladder carcinoma with respect to survival and recurrence-free survival. Bivariate and multivariate life table analyses have been performed using a set of independent variables. The most important were T class, grade (G), urinary carcinoembryonic antigen (U-CEA) taken before treatment and cytological analysis 4 months after treatment. We compared the usual way of classifying a patient (T+G) with the combination of U-CEA and cytology since the latter two variables seemed to have great prognostic importance. The analyses show that T+G gives the best significance for survival (P=0.0003) while U-CEA and cytology is better for recurrence-free survival (=0.0002). 0.0002).     

Treatment of vertebro-basilar aneurysms

Summary In continuation of investigations on classification and treatment of ICA-system aneurysms and on the classification of the vertebro-basilar-system aneurysms their treatment has been discussed. Based on this, classification has been improved and the preoperative topographic diagnosis and the choice of approach have been influenced. The operative management has been pioneered by C. G. Drake, who described the technique in detail on hand of his enormous experience with 469 aneurysms of the vertebro-basilar-system (13). The necessity of a normal aneurysm neurosurgeon treating such aneurysms requires certain modifications of indication, approach and dissection. In a personal statement based on 35 VB-aneurysms (6 per cent) the strategy of handling these aneurysms has been developed (45). Microsurgical technique is regarded absolutely necessary. Thetransoral transclival access to aneurysms of the lower clivus should be included in the approaches, similarly to the transsphenoidal operations. It facilitates the direct isolation in a very difficult region.Electrothermic dissection of the aneurysm diminishes the risk of rupture during the isolation of the sack and facilitates the isolation of the neck. The statistics of Drake provide full data for the prognosis of these aneurysms. It is to note that in the recent time the results reported from different centres became more and more similar. The embolization of large bulbous or spheric and giant aneurysms by inflatable balloon-technique possibly may replace some risky direct or indirect operations.

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Zusammenfassung In Fortsetzung unserer Untersuchungen über die mikrochirurgische Klassifikation und Behandlung der Aneurysmen des A. carotis interna-Systems, sowie die Klassifikation der Aneurysmen des Vertebro-Basilaris-Gebietes befaßt sich der Beitrag mit der Therapie letzterer. Die moderne Klassifikation und parallel dazu die präoperative angiographische Diagnostik haben die Wahl der Craniotomie und des direkten Zugangs zum Aneurysma unmittelbar beeinflußt. Die operative Behandlung ist im wesentlichen das Werk eines Mannes — Charles Drake — der die Technik anhamd seines großen Krankengutes von derzeit 469 Fällen im Detail beschrieben hat. Die Notwendigkeit für den normalen Aneurysma-Neurochirurgen, derartige Aneurysmen zu behandeln, erfordert nach meiner Überzeugung gewisse Modifikationen der Indikation, des Zuganges und der Präparation. In einer persönlichen Stellungnahme, die sich auf eine Erfahrung von 35 Aneurysmen des Vertebro-Basilaris-Gebietes stützt (6%), werden die Prinzipien des Vorgehens erläutert. Die mikrochirurgische Technik ist unerläßlich.Dertransorale transclivale Zugang sollte für bestimmte Aneurysmen der A. basilaris ebenso durchgeführt werden, wie der transsphenoidale Zugang für Hypophysenadenome selbstverständlich geworden ist. Er erleichtert die direkte Freilegung in dem sehr risikoreichen Gebiet von Brücke und Hirnnerven.Dieelektrothermische Dissektion verringert das Risiko der Ruptur während der Präparation und erleichtert die Isolierung des Aneurysmahalses.Drake's Statistik enthält alle Einzelheiten über die Prognose der verschiedenen Vertebro-Basilaris-Aneurysmen als Maßstab für das eigene Resultat. Erfahrungen der letzten Jahre aus verschiedenen Kliniken zeigen, daß die Ergebnisse sich mehr und mehr angleichen.DieEmbolisation großer bulböser und sphärischer Aneurysmen und der Riesenaneurysmen durch die Ballon-Technik erscheint geeignet, risikoreiche direkte oder indirekte Operationen zumindest teilweise zu ersetzen.

     

Frontal dysfunction in schizophrenia – a new electrophysiological classifier for research and clinical applications

We determined whether schizophrenic patients can be reliably classified with electrophysiological tools. We developed a fully computerized classifier based on 5 minutes of EEG recording during an acoustical choice reaction time task (AMDP-module IV). We included factorized variables from the frequency domain and evoked potentials (N100/P200-complex) from central and frontal electrodes, which were preprocessed in a sample of 150 normal subjects prior to classification. We applied discriminant analyses to the electrophysiological data from depressive, schizophrenic and schizotypal subjects, most of them being unmedicated or drug-naive. The classifier was developed on a training set (33 schizophrenics, 49 normals) and tested on an independent sample (32 schizophrenics, 49 normals). A simple three-variable classifier was found to classify schizophrenics and normals in 77% of those tested correctly. Diagnostic specificity of the classifier proved to be low as the inclusion of depressive patients (n= 60) significantly decreased classification power. It was demonstrated that atypical but not typical neuroleptic drugs may influence the classification results. Correctly classified schizophrenics showed significantly more negative symptoms and slower reaction times than those schizophrenics who were misclassified as normals. In contrast, these misclassified schizophrenics showed a non-significant trend for more positive symptoms and shorter reaction times. As the correctly classified schizophrenics showed increased frontally pronounced delta-activity and decreased signal power of the N100/P200 amplitude, it was concluded that these schizophrenics show dysfunction of the frontal lobe. It is proposed that this new classifier can be useful for clinical and research applications when subtyping of schizophrenics with detection of frontal dysfunction as the aim.     

Clinical Observation on Therapeutic Effects of Acupuncture Treatment for 100 Cases of Type Ⅱ Diabetes

目的:观察针刺治疗糖尿病的疗效.方法:对100例患者在适当饮食控制的基础上,电针脾俞、肾俞、肺俞、胃脘下俞、足三里、内关、三阴交、合谷和血海,并辨证加减.结果:治疗后患者空腹血糖值下降,与治疗前比有显著差异(P＜0.05);症状明显者由治疗前的85%下降到治疗后的4%.结论:针刺能降低糖尿病患者空腹血糖,在改善临床症状方面亦有明显效果.