Ecological Momentary Assessment of Social Interactions: Associations With Depression,Anxiety, Pain,and Fatigue in Individuals With Mild Stroke

ObjectivesTo examine real-time relationships between social interactions and poststroke mood and somatic symptoms in participants’ daily environments.DesignProspective observational study using smartphone-based ecological momentary assessment (EMA) surveys 5 times a day for 2 weeks. Multilevel models were used to analyze data for concurrent and lagged associations.SettingCommunity.ParticipantsAdults (N=48) with mild stroke.InterventionsNot applicable.Main Outcome MeasuresEMA measures of self-appraisal of social interactions (confidence, satisfaction, and success), as well as mood (depression and anxiety) and somatic (pain and fatigue) symptoms.ResultsIn concurrent associations, increased depressed mood was associated with reduced ratings of all aspects of social interactions. Fatigue was associated with reduced ratings of social satisfaction and success. In lagged associations, increased anxious mood preceded increased subsequent social confidence. Higher average social satisfaction, confidence, and success were related to lower momentary fatigue, anxious mood, and depressed mood at the next time point. Regarding clinicodemographic factors, being employed was concurrently related to increased social interactions. An increased number of comorbidities predicted higher somatic, but not mood, symptoms at the next time point.ConclusionsThis study provides preliminary evidence of dynamic relationships between social interactions and somatic and mood symptoms in individuals with mild stroke. Interventions to not only address the sequelae of symptoms, but also to promote participation in social activities in poststroke life should be explored.     

In vitro functional analysis of human cytochrome P450 2A13 genetic variants: P450 2A13*2, *3, *4, and *10

Humans possess three cytochrome P450 enzymes in the 2A subfamily (2A6, 2A7, and 2A13). P450 2A13 is mainly expressed in the human trachea and lung, whereas P450 2A6 is found in human liver. The P450 2A13 enzyme may be considered as the primary enzyme responsible for metabolic activation of many tobacco-specific carcinogens. Genetic variations significantly influence the toxicological consequences attributed to tobacco smoking. The aim of this study was to examine the in vitro functional activities of five P450 2A13 genetic variations (R257C, 133_134insT, R101Q, I331T, and R257C/I331T) in P450 2A13*2, *3, *4, and *10 alleles. Mutant clones were constructed and their recombinant enzymes were expressed in Escherichia coli. P450 2A13 mutants containing R257C, 133_134insT, I331T, and R257C/I331T displayed P450 holoenzyme spectra. The R101Q mutant was not apparently expressed. P450 2A13 enzymes displayed the typical type I binding spectra to coumarin and the calculated binding affinities of R257C, R257C/I331T, and 133_134insT mutants were decreased approximately three- to sevenfold. In catalytic analyses of purified mutant enzymes for coumarin and nicotine, the R257C and I331T mutants exhibited lower k_cat values with catalytic efficiencies reduced up to approximately 20%. The double mutation of R257C/I331T induced increased K_m values and diminished k_cat values that resulted in >50% decrease in catalytic efficiencies. For 133_134insT mutant, catalytic activities were not markedly saturated but the measured rates at the highest concentrations were significantly lower than those of the wild-type or other mutant enzymes. Functional analysis of these variations in P450 2A13 allelic variants may help to understand the consequences of P450 2A13 polymorphism in bioactivation of many tobacco-derived carcinogens.     

An oral hygiene brochure for your implant overdenture patients

Although there may not be a direct association between oral hygiene and implant failure, oral hygiene must be maintained around implants in the edentulous mouth. Bacterial plaque on dentures can act as a reservoir for pathogens that cause respiratory disease. Unfortunately, many edentulous patients have poor oral hygiene. In this article, we describe the development of a brochure to educate patients wearing mandibular overdentures supported by 2 implants as a supplement to the dentist"s verbal instructions. Dental literature and several specialists were consulted during preparation of the brochure, which contains photographs accompanying oral hygiene instructions. It was sent to 25 participants who were subsequently called and questioned regarding its content and their oral hygiene habits. The 24 respondents found the brochure useful; most reported that they would keep the brochure for future reference and that they learned something new about how to maintain their implants properly. No one found the brochure too long or unclear. Most participants read the brochure entirely, rather than skimming it. The brochure is available to all clinicians who wish to incorporate this tool into their implant overdenture therapeutic approach.     

Periodontal status of adults with systemic sclerosis: case-control study

Background: Systemic sclerosis (SSc) is a systemic autoimmune disease that affects connective tissue in the skin, blood vessels, and major organs of the body. This project aims to compare the periodontal status of dentate Hong Kong Chinese with and without SSc. Methods: Thirty‐six non‐smoking adults with SSc (one male and 35 females: aged 50.6 ± 11.7 years; free from Sjögren syndrome) attending a teaching hospital were age‐ and sex‐matched to systemically healthy controls attending a dental hospital. Both groups had similar demographic characteristics but a lower proportion of patients with SSc were working or studying (P <0.05). Twenty‐three (32%) of all participants were regular dental attendees. Orthopantomogram radiographs were taken. Participants were surveyed and periodontally examined. Results: Both groups had a similar number of erupted teeth, proportion of sites with detectable plaque, and mean full‐mouth clinical attachment level, whereas controls had less bleeding on probing (49.3% ± 22.6% versus 78.4% ± 19.6%; P <0.001) and a shallower mean full‐mouth probing depth (1.92 ± 0.44 mm versus 2.52 ± 0.58 mm; P <0.001). Radiographically, patients with SSc had wider periodontal ligament spaces (0.36 ± 0.06 mm versus 0.33 ± 0.03 mm; P <0.01). Conclusions: Hong Kong Chinese adults with SSc seem to exhibit higher levels of periodontal inflammation and wider radiographic periodontal ligament spaces than age‐ and sex‐matched controls. Future studies are warranted to further investigate any associations between these periodontal features and SSc.     

Prestroke Statins,Progression of White Matter Hyperintensities,and Cognitive Decline in Stroke Patients with Confluent White Matter Hyperintensities

Cerebral white matter hyperintensities (WMH) are a consequence of cerebral small vessel disease. Statins have been shown to reduce recurrent stroke among patients with various stroke subtypes, including lacunar stroke, which also arises from small vessel disease. In this study, we investigated the hypothesis that prestroke statin use would reduce the progression of WMH and/or cognitive decline among stroke patients with confluent WMH. Patients (n = 100) were participants of the VITAmins To Prevent Stroke magnetic resonance imaging substudy. All patients had confluent WMH on magnetic resonance imaging at baseline. Eighty-one patients completed the 2-year follow-up. We assessed general cognition and executive function using the mini-mental state examination and Mattis dementia rating scale–initiation/perseveration subscale, respectively. We compared the change in volume of WMH and cognition between prestroke statin use and prestroke nonstatin use groups. We also evaluated the effects of prestroke statin use on incident lacunes and microbleeds. The prestroke statin use group (n = 51) had less WMH volume progression (1.54 ± 4.52 cm³vs 5.01 ± 6.00 cm³, p = 0.02) compared with the prestroke nonstatin use group (n = 30). Multivariate linear regression modeling identified prestroke statin use as an independent predictor of WMH progression (β = –0.31, p = 0.008). Prestroke statin use was also associated with less decline (Mattis dementia rating scale–initiation/perseveration subscale; β = 0.47, p = 0.001). No association was observed with changes in mini-mental state examination scores. There were no between group differences on incident lacunes or incident microbleeds. Prestroke statin use may reduce WMH progression and decline in executive function in stroke patients with confluent WMH.

Electronic supplementary material

The online version of this article (doi:10.1007/s13311-014-0270-5) contains supplementary material, which is available to authorized users.     

Ipsilateral motor pathway confirmed by combined brain mapping of a patient with hemiparetic stroke: a case report

This study investigated the motor control pathway using both functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) in a patient with left hemiparesis with an infarction on the posterior limb of the right internal capsule. fMRI was performed using the blood oxygen level-dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of hand grasp-release movements in 1-Hz cycles. TMS was performed using a butterfly coil; the intersection of the wings (center of the coil) was applied tangentially to the scalp 1.0 cm apart. Stimulation was performed at 100% of maximal output. Motor evoked potentials (MEPs) from both abductor pollicis brevis (APB) muscles were obtained simultaneously. fMRI showed that the unaffected (left) primary sensorimotor cortex (SM1) was activated by movements of the unaffected (right) hand. Conversely, the bilateral SM1 were activated by movements of the affected (left) hand. Brain mapping using TMS showed that ipsilateral MEPs were obtained at the affected (left) APB muscle when the unaffected (left) motor cortex was stimulated. We concluded that the ipsilateral motor pathway from the unaffected motor cortex to the affected hand was present in this patient.     

Association between serum adipocytokine levels and microangiopathies in patients with type 2 diabetes mellitus

Aims/Introduction

It is thought that adipocytokines contribute to the increased risk of vascular complications in type 2 diabetes. However, there is still limited information on the relationship between microangiopathies and adipocytokines, such as adiponectin, leptin and tumor necrosis factor‐α (TNF‐α) in patients with type 2 diabetes.

Materials and Methods

The present study examined the relationship between fasting serum adiponectin, leptin, and TNF‐α levels and microangiopathies in Korean type 2 diabetes. A total of 153 patients were recruited and evaluated for diabetic nephropathy, retinopathy and neuropathy. Serum adiponectin, TNF‐α and leptin levels were measured.

Results

Serum adiponectin levels were significantly lower in patients with nephropathy than in those without nephropathy (P = 0.017), and were significantly higher in patients with retinopathy or neuropathy than those without retinopathy or neuropathy (P = 0.01 and P = 0.002, respectively). The mean levels of leptin were significantly higher in patients with neuropathy than in those without neuropathy (P = 0.002). The mean levels of TNF‐α were not significantly different according to any of the three microangiopathies. Multivariate logistic regression analysis showed that the odds ratio for the presence of neuropathy in the highest tertile of adiponectin was 4.3 (95% confidence interval 1.59–11.62), as compared with the patients in the lowest tertile of adiponectin level.

Conclusions

Levels of adipocytokines were significantly different according to the presence of each microangiopathy. In particular, higher serum adiponectin was independently associated with increased odds for the presence of neuropathy. Future prospective studies with larger numbers of patients are required to establish a direct relationship between plasma adipocytokine concentrations and the development or severity of diabetic microangiopathies.