Early Stroke Recognition: Developing an Out-of-hospital NIH Stroke Scale

Objective : To develop an abbreviated and practical neurologic scale that could assist emergency medical services or triage personnel in identifying patients with stroke.
Methods : A prospective, observational, cohort study was performed at university-based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non-stroke patients evaluated during 4 random 12-hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using χ² were performed to rank items. Recursive partitioning was then performed to develop the decision rule for predicting the presence of stroke.
Results : Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NIH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out-of-hospital NIH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%.
Conclusion : Using the derivation data set, a proposed Out-of-hospital NIH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out-of-hospital arena are needed.     

Restless legs syndrome in Parkinson's disease: a case-controlled study.

Restless legs syndrome (RLS) is a disorder of motor activity with a circadian pattern, occurring frequently in patients with Parkinson's disease (PD). We sought to estimate the prevalence of RLS in Indian PD patients. One hundred twenty-six consecutive PD patients and 128 healthy age- and sex-matched controls were evaluated using a predesigned questionnaire. RLS was present in 10 of 126 cases of PD (7.9%) and 1 of 128 controls (0.8%, P = 0.01). PD patients with RLS were older than those without RLS (63.70 +/- 7.80 years vs. 57.37 +/- 10.04 years; P = 0.05) and had higher prevalence of depression (40% vs. 10.3%; P = 0.023). No demographic factors or factors related to PD correlated with the presence or severity of RLS. RLS is more common among patients with PD than controls. A greater medical recognition of this disorder is needed in view of available effective treatment.     

Comparison of the treadmill exercise score and single-photon emission computed tomographic thallium imaging in risk assessment

Background  

This study compared the prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging with that of treadmill exercise score in medically treated patients with coronary artery disease (CAD)     

Dietary intake in the elderly estimated by a 24 hour recall and a food frequency questionnaire

Two hundred and thirty-five tenants living in sheltered housing in Scotland were surveyed to identify the extent of under-nutrition and the social factors which contribute to its development. A validated 24 h recall and the nutrient checklist published by NAGE were used to evaluate patterns of dietary intake. A questionnaire was developed which included scales designed to measure depression, social engagement, cognitive function, mobility and functional ability. The results show considerable evidence of a number of major nutrients in which there were low intakes. In order to express the extent of poor nutrition, a nutrient score was developed where points are awarded based on the number of nutrients falling below the Lower Reference Nutrient Intake, the Estimated Average Requirement or below half the daily Estimated Average Requirement.     

Non-invasive dynamic assessment of the elasticity of intracranial structures

The dynamics of the speed of transcranial propagation of ultrasonic impulses has been established in humans. The possibility of detecting the changes in mechanical state of intracranial structures by dynamic measurement of the time of transcranial propagation of ultrasonic impulses (TUPT) has been ascertained for 10 healthy persons and 11 patients with different neurological pathology. The cerebrospinal fluid pressure (CSFP) was simultaneously monitored for 4 of the patients. Spontaneous fluctuations in TUPT and the changes caused by jugular veins, inferior vena cava compression, hyperventilation and temporary retention of breathing were detected for all investigated subjects. Spontaneous TUPT changes in the range of 0.25-0.85 x 10(-4) of initial mean value, which are related with cardiac and respiratory cycles, have been found in healthy persons while in patients they ranged from 0.07 x 10(-4) to 4.5 x 10(-4) of mean time. In healthy persons bilateral jugular vein compression leads to a decrease in TUPT by 1.8-3.0 x 10(-4), while the compression of inferior vena cava gives an increase in TUPT by 1.6-2.6 x 10(-4). Changes in TUPT during these maneuvers in neurological patients were found to be of different amplitude and direction. The rise of CSFP by 8.4-20.2 mmHg (mean 12.4 mmHg) was observed in 4 investigated patients during the compression of jugular veins or during the inferior vena cava compression, while the changes in TUPT obtained during each of such maneuvers were of opposite character. The results suggest that dynamic evaluation of acoustic impedance of intracranial system reflects the changes in the mechanical state of brain parenchyma.     

运用Cox模型和Sokal,Hasford积分系统对慢性髓细胞白血病患者的预后分析

本研究分析影响慢性髓细胞白血病（CML）患者预后的危险因素。采用回顾性研究分析204例CML患者的临床及实验室检查资料，用Kaplan—Meier法绘制生存曲线，用Logrank检验比较生存率，运用Cox回归模型进行单因素及多因素分析，并分别计算Sokal，Hasford积分。结果表明：204例患者中位生存时间为50（32—65）月，5年生存率32．3％（95％CI，23．7％-42．6％）。干扰素组与羟基脲组的中位生存时间分别为56（41—67）月和41（19—56）月，5年生存率分别为45．4％（95％CI，37．5％-54．2％）和26．8％（95％CI，21．6％-33．3％）（P〈0．001）。经Cox回归分析，Ph染色体阴性、乳酸脱氢酶含量增高、外周血嗜碱性粒细胞≥10％、出现有核红细胞、骨髓原粒细胞≥4％、骨髓原始＋早幼粒细胞≥10％和红细胞压积降低是CML预后不良的危险因素，而治疗方法也是影响CML预后的重要因素。羟基脲组经Sokal积分检验，高危组占72．9％，中危组占21．5％，而低危组占5．6％，中位生存时间分别为34（23—49）月、43（32—58）月、50（38—62）月；干扰素组经Hasford积分检验，高危组占17．6％，中危组占25．1％，低危组占57．3％，中位生存时间分别为44（33—57）月、56（45—70）月和66（52—76）月。结论：Ph染色体、乳酸脱氢酶含量、红细胞压积、外周血嗜碱性粒细胞、出现有核红细胞、骨髓原始和早幼粒细胞以及治疗方法是影响CML预后的重要因素。以Sokal积分系统评价羟基脲组患者不能很好区分危险组，而Hasford积分系统评价干扰素组患者，能够区分危险组。     

Routinely collected general practice data aids identification of people with hyperglycaemia and metabolic syndrome.

AIMS: To assess the performance of a risk score comprising data routinely available in general practice records (age, gender, body mass index, family history of diabetes, smoking habits and prescribed anti-hypertensive drugs or steroids) in detecting diabetes, impaired glucose tolerance and metabolic syndrome. METHODS: In a population-based, cross-sectional study in a semi-rural general practice in Jutland, Denmark, Cambridge Risk Scores were calculated for 1355 patients without known diabetes (69% response rate) who completed questionnaires and underwent anthropometric measurement and an oral glucose tolerance test. RESULTS: Prevalences of diabetes, impaired glucose tolerance and metabolic syndrome were 2.29% (95% CI: 1.56-3.23), 6.64% (95% CI: 5.38-8.10) and 13.4% (95% CI: 11.5-15.2), respectively. Area under the ROC curve for the risk score and diabetes was 83.8% (75.9-91.7) and for metabolic syndrome [European Group for the Study of Insulin Resistance (EGIR)] was 78.1% (74.6-81.6). Twenty per cent of the population had a risk score above 0.246; at this threshold the sensitivity to detect diabetes was 71.0% (53.4-83.9), the specificity 81.2% (79.0-83.2), positive predictive value 8.1% (6.6-10.0) and likelihood ratio 3.77 (2.94-4.85). For metabolic syndrome (EGIR) corresponding values for sensitivity were 50.3% (43.1-57.5), specificity 84.7% (82.5-85.6), positive predictive value 33.6% (28.2-39.4), and likelihood ratio 3.28 (2.69-4.00). CONCLUSIONS: Undiagnosed hyperglycaemia and metabolic syndrome are common. The Cambridge Risk Score is a practical first step in a screening procedure to identify individuals with these disorders who might benefit from diagnostic testing or to direct preventive interventions.     

不同剂量普伐他汀治疗急性脑梗死的疗效和安全性研究

目的：探讨不同剂量普伐他汀在脑梗死急性期治疗的可行性、降脂疗效及安全性。方法：脑梗死急性期病人146例，随机分为3组，A组（50例）为对照组，B组（49例）每晚服普伐他汀10mg，C组（47例）每晚服普伐他汀20mg，观察30d。比较治疗前后血脂、神经功能缺损评分、生化指标等变化，并记录服药后不良反应。结果：各组总胆固醇（TC）、低密度脂蛋白（LDL-C）、超敏C-反应蛋白（hs-CRP）在治疗后都有所下降，C组下降最显著，B组次之，A组下降程度较小。A组TG治疗前后无明显变化，B组和C组TG治疗后有所下降，两组间无明显差别。脂蛋白（Lpa）在A组治疗后有下降，B组无明显变化，C组较前轻度升高。各组治疗前后神经功能缺损评分均有降低，但各组之间比较无明显差异（P〉0.05）。观察期间所有病人均能耐受普伐他汀，治疗前后肝、肾功能、肌酸激酶（CK）等无明显变化。结论：在脑梗死急性期应用普伐他汀（每日10～20mg）是安全可行的，且每日20mgTC、TG降低更显著，脑梗死急性期的病人应用普伐他汀后取得较好的降脂疗效，神经功能缺损评分的改善有待较长期观察。