APOE gene polymorphisms and susceptibility to Creutzfeldt–Jakob disease

Associations between apolipoprotein E (APOE) gene polymorphisms and Creutzfeldt–Jakob disease (CJD) have been reported, but the results from many of these studies are conflicting. To investigate the association between APOE polymorphisms and CJD risk, we performed a meta-analysis. We used odds ratios (OR) with 95% confidence intervals (CI) to assess the strength of the association. The frequency of putative risk alleles in control subjects was estimated with the Mantel-Haenszel method. Cochran’s Q statistic and the inconsistency index (I²) were used to test heterogeneity. Egger’s test and an inverted funnel plot were used to assess bias. Our study included 11 published case–control studies with APOE genotyping, involving a total of 1001 CJD patients and 1211 controls. Overall, the APOE 34 (OR 1.37, 95% CI: 1.09–1.72), and APOE 44 (OR 3.16, 95% CI: 1.37–7.26) genotypes and the APOE 4 (OR 1.41, 95% CI: 1.08–1.85) allele were associated with an increased risk of CJD, and the APOE 33 (OR 0.81, 95% CI: 0.67–0.97) genotype tended to protect against CJD. However, we did not find significant evidence supporting associations of the APOE 22 (OR 1.15, 95% CI: 0.45–2.93), APOE 23 (OR 0.84, 95% CI: 0.64–1.09), or APOE 24 (OR 1.40, 95% CI: 0.70–2.77) genotypes, nor the APOE 2 (OR 1.02, 95% CI: 0.73–1.42) or APOE 3 (OR 0.82, 95% CI: 0.65–1.02) alleles with CJD using a fixed-effects model. Our results support a genetic association between APOE polymorphisms and CJD.     

Sleep duration and obesity among adults: a meta-analysis of prospective studies

BackgroundResults from longitudinal studies on sleep duration and incidence of obesity remain controversial.MethodsPubMed and Web of Science updated on 20 February 2014 were searched for eligible publications. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using a random-effects model.ResultsEleven published articles were included, involving 197,906 participants for short sleep duration and 164,016 participants for long sleep duration. Compared with the normal sleep duration, the pooled OR for obesity was 1.45 (95% CI, 1.25–1.67) for the short sleep duration overall. After removing the three studies that had strong effects on heterogeneity, the pooled OR was 1.25 (95% CI, 1.14–1.38). The positive association was consistent among all subgroups analysis except in the European group (OR, 1.45; 95% CI, 0.79–2.64). No significant association was found between long sleep duration and risk of obesity overall (OR, 1.06; 95% CI, 0.98–1.15) and in subgroup analysis.ConclusionThis meta-analysis indicated that short sleep duration was significantly associated with incidence of obesity, whereas long sleep duration had no effect on future obesity among adults.     

昏迷危险因素的病例对照研究

目的研究昏迷发病的危险因素。方法连续收集223例住院的昏迷病人作为病人组(昏迷组).以同期住院的223例危重非昏迷病人为对照组(非昏迷组)。采用统一调查表和诊断标准对所有对象的一般情况、原发或主要疾病、急性并发症或器官衰竭、慢性脏器功能障碍等进行调查。应用单因素和多因素分析方法对有关因素进行分析。结果单因素分析表明,符合3项和4项标准的全身炎症反应综合征(SIRS 3-4)、急性呼吸衰竭、休克、急性肾衰、血糖过高、继发性全身性癫痫、第二原发疾病、原有脑软化,是昏迷的危险因素(P<0.05)。Logistic回归在校正了休克等因素后,SIRS3-4(OR=7.8,95％CI=4.307-14.001)、急性呼吸衰竭(OR=5.2,95％CI=1.683-16.242),继发性全身性癫痫(OR=2.6,95％CI=1.095-5.998)仍与昏迷密切有关。结论除昏迷的原发疾病外,多种急性并发症或器官衰竭,包括SIRS 3-4、急性呼吸衰竭、继发性全身性癫痫等,也是昏迷的主要危险因素。这些危险因素可以联合或单独作用引起昏迷。     

Risk factors for intensive care unit‐acquired weakness: A systematic review and meta‐analysis

Intensive care unit‐acquired weakness (ICUAW) occurs frequently in the context of critical illness without alternative plausible cause and specific treatment options, and it is important to identify and summarize the independent risk factors for ICUAW. PubMed, Embase, Central, China Biological Medicine, China National Knowledge Infrastructure, VIP and Wanfang databases were searched from database inception until 10 July 2017. Prospective cohort studies on adult ICU patients who were diagnosed with ICUAW using either clinical or electrophysiological criteria were selected. Meta‐analysis was performed using Stata version 12.0. The results were analysed using odds ratios (OR) and 95% confidence intervals (CI). Data were pooled using a random‐effects model, and heterogeneity was assessed using the I² statistic. Qualitative analysis and systematic review were used for risk factors that were deemed inappropriate to combine. Fourteen prospective cohort studies were included in this review. The meta‐analysis showed that Acute Physiology and Chronic Health Evaluation II score (OR, 1.05; 95%CI, 1.01‐1.10), neuromuscular blocking agents (OR, 2.03; 95%CI, 1.22‐3.40) and aminoglycosides (OR, 2.27; 95%CI, 1.07‐4.81) were found to be significantly associated with ICUAW. Other risk factors, including female, multiple organ failure, systemic inflammatory response syndrome, sepsis, electrolyte disturbances, hyperglycaemia, hyperosmolarity, high lactate level, duration of mechanical ventilation, parenteral nutrition and use of norepinephrine, were statistically significant on multivariable analysis in each single studies. This review provides a number of independent risk factors for ICUAW, which should be guided for early prediction and prevention of the disorder.     

Chronic fatigue and minor psychiatric morbidity after viral meningitis: a controlled study.

OBJECTIVE--To test the hypotheses that patients exposed to viral meningitis would be at an increased risk of developing chronic fatigue syndrome and would have an excess of neurological symptoms and physical impairment. METHODS--Eighty three patients were followed up 6-24 months after viral meningitis and a postal questionnaire was used to compare outcome with 76 controls who had had non-enteroviral, non-CNS viral infections. RESULTS--For the 159 patients and controls the prevalence of chronic fatigue syndrome was 12.6%, a rate higher than previously reported from primary care attenders, suggesting that moderate to severe viral infections may play a part in the aetiology of some fatigue states. Those with a history of meningitis showed a slight, non-significant increase in prevalence of chronic fatigue syndrome (OR 1.4; 95% CI 0.5-3.6) which disappeared when logistic regression and analysis was used to correct for age, sex, and duration of follow up (OR 1.0; 95% CI 0.3-2.8). Controls showed marginally higher psychiatric morbidity measured on the general health questionnaire-12 (adjusted OR 0.6; 95% CI 0.3-1.3) Both groups had similar rates of neurological symptoms and physical impairment. The best predictor of chronic fatigue was a prolonged duration time of off work after the illness (OR 4.93, 95% CI 1.3-18.8). The best predictor of severe chronic fatigue syndrome diagnosed by Center for Disease Control criteria was past psychiatric illness (OR 7.82, 95% CI 1.8-34.3). Duration of viral illness, as defined by days in hospital, did not predict chronic fatigue syndrome. CONCLUSIONS--(1) The prevalence of chronic fatigue syndrome is higher than expected for the range of viral illnesses examined; (2) enteroviral infection is unlikely to be a specific risk factor for its development; (3) onset of chronic fatigue syndrome after a viral infection is predicted by psychiatric morbidity and prolonged convalescence, rather than by the severity of the viral illness itself.     

Catecholamines, infection, and death in acute ischemic stroke

Experimental studies have recently suggested that acute ischemia may facilitate the appearance of fatal infections as part of a brain-induced immunodepression syndrome. However, the mechanisms and neurological consequences of infections complicating acute ischemic stroke have received much less attention at the bedside. The incidence of infection and death after non-septic stroke was compared in this prospective study with longitudinal changes of cytokines, leukocytes, normetanephrine (NMN) and metanephrine (MN) in 75 consecutive patients. In multivariate analysis, infection, n = 13 (17%), was associated with the upper quartile of MN (OR 3.51, 95% CI 1.30-9.51), neurological impairment (NIHSS) on admission (OR 3.99, 95% CI 1.34-11.8), monocyte count (OR 1.78, 95% CI 1.13-2.79), and increased interleukin (IL)-10 (OR 1.54, 95% CI 1.00-2.38). Mortality at 3 months, n = 16 (21%), was associated with increased levels of NMN on admission (OR 2.34 95% CI 1.15-4.76), NIHSS score (OR 2.57, 95% CI 1.29-5.11), and higher IL-6 levels (OR 1.29, 95% 1.00-1.67). These findings suggest that acute ischemic stroke is associated with an early activation of the sympathetic adrenomedullar pathway that lowers the threshold of infection and increases the risk of death. Moreover, these findings are independent of the blood borne effects of pro- and anti-inflammatory cytokines, and circulating leukocytes.     

The association of metabolic syndrome with reflux esophagitis: a case-control study

Background Obesity has been associated with reflux esophagitis. However, the association of metabolic syndrome with reflux esophagitis remains unknown. Methods A case‐control study of 372 subjects undergoing upper endoscopy during health checkups was conducted (182 patients with reflux esophagitis vs 190 age and gender‐matched controls). We further measured their height, weight, waist circumference, hip circumference, blood pressure, triglyceride, high‐density lipoprotein, and fasting blood glucose. Multivariable linear regression analysis was used to identify the independent risk factors associated with the presence of reflux esophagitis. Key Results Reflux esophagitis cases showed higher mean waist circumference (81.37 ± 0.68 vs 79.36 ± 0.70, P < 0.05), waist hip ratio (0.86 ± 0.01 vs 0.84 ± 0.01, P < 0.05) and fasting blood glucose (5.59 ± 0.10 vs 5.32 ± 0.08, P < 0.05) than those in controls. When adjusted for gender and age, multivariate analysis demonstrated that there was a positive dose‐response relationship between reflux esophagitis and waist hip ratio (men: OR 3.41, 95% CI 1.52–7.62, women: OR 3.37, 95% CI 1.61–7.06), triglyceride (OR 2.07, 95% CI 1.12–3.82), fasting blood glucose (OR 1.81, 95% CI 1.12–2.94), and metabolic syndrome (OR 2.01, 95% CI 1.15–3.50), there was an inverse dose‐response relationship between reflux esophagitis and high‐density lipoprotein for men (OR 0.36, 95% CI 0.15–0.85). Conclusions & Inferences High waist hip ratio, triglyceride, fasting blood glucose, and metabolic syndrome were associated with increased risk factors for reflux esophagitis while high high‐density lipoprotein for men correlated with a reduced risk of reflux esophagitis.     

Prevalence and Predictors of Stroke in Patients with Crohn's Disease: A Nationwide Study

ObjectivesMounting evidence points to the microbiome as a susceptibility factor for neurological disorders. Patients with Crohn's disease (CD) are at higher ischemic stroke (IS) risk, but no large scale epidemiologic studies have identified risk factors for stroke in this population.Materials and MethodsWe analyzed the 2017 Nationwide Inpatient Sample (NIS) dataset to identify patients with a discharge diagnosis of Crohn's disease using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code K50.X. We identified patients with a primary/secondary discharge diagnosis of IS using ICD-10-CM code I63.X. We compared sociodemographic and clinical variables between stroke and non-stroke patients with CD. Logistic regression analysis was applied to identify factors associated with IS.ResultsOf 30,212 patients with CD, 369 (1.2 %) had a discharge diagnosis of IS. Older age (odds ratio [OR], 1.03 [95% CI, 1.02–1.04], top quartile income (OR, 1.58 [95% CI, 1.10–2.30]), and hospitalization in a South Atlantic (OR, 1.82 [95% CI, 1.11-3.14]), East South Central (OR, 2.30 [95% CI, 1.28-4.25]), or West South Central hospital (OR, 2.40 [95% CI, 1.39-4.28]) were independently associated with IS. Clinical variables independently associated with IS in patients with CD included: atrial fibrillation (OR, 1.66 [95% CI, 1.15-2.33]), atherosclerosis (OR, 2.41 [95% CI, 1.32-4.10]), hyperlipidemia (OR, 1.69 [95% CI, 1.33-2.15]), hypertension (OR, 1.53 [95% CI, 1.18-1.98]) and valvular disease (OR, 1.62 [95% CI, 1.01-2.48).ConclusionA subset of traditional stroke risk factors are associated with IS in patients with CD. CD patients with these conditions could be targeted for vascular risk reduction and surveillance.     

精神分裂症患者发生代谢综合征危险因素研究

目的 探讨精神分裂症患者代谢综合征发生的危险因素,方法 以是否发生代谢综合征为标准,将84例单一服用氯氮平治疗的精神分裂症患者分为两组,其中代谢综合征组36例,非代谢综合征组48例.收集患者的一般资料,包括性别,年龄,吸烟史,教育程度,婚姻状况,服药剂量,服药时间,晨起空腹状态下测定患者的体重,身高,腰围,血压,空腹血糖,总胆固醇,甘油三酯,低密度脂蛋白,高密度脂蛋白,C-反应蛋白,IL-6,比较分析两组一般资料和所测定指标的差异.结果 代谢综合征组患者的吸烟率(P=0.006),腰围(P=0.001),空腹血糖(P＜0.001),甘油三酯(P=0.008),C-反应蛋白(P＜0.001)和白介素-6 (P＜0.001)水平明显高于非代谢综合征组,两组间差异具有统计学意义.以是否发生代谢综合征为因变量,建立Logistic回归模型,血糖(95％ CI,OR:5.5,27.03),收缩压(95％CI,OR:1.84,2.39),年龄(95％ CI,OR:1.17,1.37),腰围(95％ CI,OR:1.83,3.07),甘油三酯(95％ CI,OR:23.08,45.26),C-反应蛋白(95％ CI,OR:1.08,2.94)这6个变量进入回归方程.结论 发生代谢综合征的精神分裂症患者,具有更高的吸烟比率,腰围,空腹血糖,甘油三酯和C-反应蛋白水平,而空腹血糖,收缩压,年龄,腰围,甘油三酯和C-反应蛋白是代谢综合征发生的独立危险因素,可以作为预测指标,做到代谢综合征的早期预防和干预.     

Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada

BACKGROUND: Venous thromboembolism (VTE) prophylaxis in acutely ill medical patients has been shown to be safe and effective. Underutilization of this patient safety practice may result in avoidable mortality and morbidity. OBJECTIVES: We aimed to determine the proportion of hospitalized, acutely ill medical patients across Canada who were eligible to receive thromboprophylaxis and to evaluate the frequency, determinants and appropriateness of its use. PATIENTS/METHODS: CURVE is a national, multicenter chart audit of 29 Canadian hospitals. Data were collected on consecutive patients admitted to hospital for an acute medical illness during a defined 3-week study period. Information on demographic and clinical characteristics, risk factors for VTE and bleeding and use of VTE prophylaxis were recorded. The indications for and appropriateness of VTE prophylaxis were assessed using pre-specified criteria based on international consensus guidelines. Multivariable analyses were performed to identify determinants of prophylaxis use. RESULTS: Of the 4124 medical admissions screened over the study period, 1894 patients (46%) were eligible for study inclusion. The most common specified admitting diagnoses were severe infection (28%), COPD exacerbation or respiratory failure (12%), malignancy (9%) and congestive heart failure (8%). Thromboprophylaxis was indicated in 1702 (90%) study patients. Overall, some form of prophylaxis was administered to 23% of all patients. However, only 16% received appropriate thromboprophylaxis. Factors independently associated with greater use of prophylaxis included internist (vs. other specialty) as attending physician (OR 1.33, 95% confidence interval (CI) [1.03, 1.71]), university-associated (vs. community) hospital (OR 1.46, 95% CI [1.03, 2.07]), immobilization (per day) (OR 1.60, 95% CI [1.45, 1.77]), presence of >or=1 VTE risk factors (OR=1.78, 95% CI [1.35, 2.34]) and duration of hospitalization (per day of stay) (OR 1.05, 95% CI [1.03, 1.07]), however, use of prophylaxis was unacceptably low in all groups. Patients with cancer had a significantly reduced likelihood of receiving prophylaxis (OR=0.40, 95% CI [0.24, 0.68]). Presence of risk factors for bleeding did not influence the use or choice of prophylaxis. CONCLUSION: Most patients hospitalized for medical illness had indications for thromboprophylaxis, yet only 16% received appropriate prophylaxis. Efforts should be made to elucidate the reasons that underlie the very low rate of thromboprophylaxis in medical patients and to develop and test strategies to improve implementation of this patient safety practice.     

Corticosteroid use and risk of aneurysmal subarachnoid haemorrhage

OBJECTIVES: Corticosteroids can induce hypertension and inhibit collagen synthesis in the blood vessel wall. Deficiencies in collagen have been found in intracranial aneurysms. Therefore use of corticosteroids could be a risk factor for intracranial aneurysms and aneurysmal subarachnoid haemorrhage (SAH). We investigated the relationship between the systemic use of corticosteroids in the past and the occurrence of aneurysmal SAH. METHODS: We compared the systemic use of corticosteroids (oral or intravenous) in the past between a consecutive series of 1158 patients with aneurysmal SAH and a control group consisting of 1019 patients diagnosed with a primary central nervous system (CNS) tumour. We discriminated between definite use of corticosteroids defined as use mentioned in the medical record and possible use defined as note in the medical record of a disease that may be treated with corticosteroids. We calculated odds ratios (OR) with corresponding 95% confidence intervals (CI) and adjusted for age and sex by means of logistic regression analyses. RESULTS: Twenty (1.7%, 95% CI 1.1-2.7) of the SAH patients and eight (0.8%, 95% CI 0.3-1.5) of the controls had used systemic corticosteroids (OR: 2.22; 95% CI 0.97-5.05; p-value 0.058; adjusted OR 2.23; 95 % CI 0.97-5.15; p-value 0.059). For definite plus possible use the OR was 1.67 (95% CI 1.09-2.54; p-value 0.016) and the adjusted OR 1.52 (95% CI 0.99-2.33; p-value 0.055). CONCLUSIONS: Patients with aneurysmal SAH more often have used systemic corticosteroids in the past than controls. This may suggest that the use of corticosteroids is a risk factor for aneurysmal SAH.     

Preterm birth or foetal growth impairment and psychiatric hospitalization in adolescence and early adulthood in a Swedish population-based birth cohort

Objective: Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder. Our aim was therefore to investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization. Method: A population‐based registry study of psychiatric hospitalization of in total 155 994 boys and 148 281 girls born in Sweden in 1973–1975. Results: The risk of hospitalization for all mental disorders was increased for preterm SGA boys (OR 2.19, 95% CI 1.49–3.21); at‐term SGA boys (OR 1.55, 95% CI 1.34–1.79); at‐term SGA girls (OR 1.31, 95% CI 1.15–1.50). At‐term SGA boys and girls suffered increased risk of anxiety and adjustment disorders (OR 1.70, 95% CI 1.18–2.45 and OR 1.49, 95% CI 1.14–1.94). Preterm SGA boys were at risk of personality disorders (OR 3.30, 95% CI 1.16–9.41) and psychotic disorders (OR 4.36, 95% CI 1.85–10.30). Conclusion: The results show a relationship between being born SGA and later psychiatric hospitalization, where preterm birth and male gender seem to increase the risk.     

A Randomized Trial of Central Venous Catheter Type and Thrombosis in Critically Ill Neurologic Patients

Background

Observational studies suggest peripherally inserted central venous catheters (PICCs) are associated with a high risk of catheter-related large vein thrombosis (CRLVT) in critically ill neurologic patients. We evaluated the difference in thrombosis risk between PICCs and centrally inserted central venous catheters (CICVCs).

Methods

We conducted a pragmatic, randomized controlled trial of critically ill adult neurologic patients admitted to neurological and trauma critical care units at two level I trauma centers. Patients were randomized to receive either a PICC or CICVC and undergo active surveillance for CRLVT or death within 15 days of catheter placement.

Results

In total, 39 subjects received a PICC and 41 received a CICVC between February 2012 and July 2015. The trial was stopped after enrollment of 80 subjects due to feasibility affected by slow enrollment and funding. In the primary intention-to-treat analysis, 17 (43.6 %) subjects that received a PICC compared to 9 (22.0 %) that received a CICVC experienced the composite of CRLVT or death, with a risk difference of 21.6 % (95 % CI 1.57–41.71 %). Adjusted common odds ratio of CRLVT/death was significantly higher among subjects randomized to receive a PICC (adjusted OR 3.08; 95 % CI 1.1–8.65). The higher adjusted odds ratio was driven by risk of CRLVT, which was higher in those randomized to PICC compared to CICVC (adjusted OR 4.66; 95 % CI 1.3–16.76) due to increased large vein thrombosis without a reduction in proximal deep venous thrombosis.

Conclusions

Our trial demonstrates that critically ill neurologic patients who require a central venous catheter have significantly lower odds of ultrasound-diagnosed CRLVT with placement of a CICVC as compared to a PICC.

     

Critical illness polyneuropathy and myopathy: clinical features, risk factors and prognosis

Acquired neuromuscular weakness due to critical illness polyneuropathy and myopathy (CIPNM) frequently develops in patients hospitalized in the intensive care unit for more than 1 week. CIPNM may present with muscle weakness and failure to wean from mechanical ventilation, but is discovered more often and earlier by electrophysiological examination. In this review, the incidence, clinical and electrophysiological features, differential diagnosis and prognosis of CIPNM will be described. Risk factors for CIPNM are sepsis or systemic inflammatory response syndrome and the severity of multi-organ failure. Presence of CIPNM is associated with higher mortality rate, prolonged duration of mechanical ventilation and prolonged rehabilitation. The majority of survivors with CIPNM have persistent functional disabilities and a reduced quality of life. There is need for new therapeutic strategies to prevent or minimize CIPNM in critically ill patients.     

Dyspepsia and constipation in patients with schizophrenia spectrum disorders

Constipation and dyspepsia are disturbing gastrointestinal symptoms that are often ignored in research on physical comorbidities of schizophrenia. The aim was to assess dyspepsia and constipation in a sample of outpatients with schizophrenia spectrum psychoses. A general practitioner performed a thorough physical health check for 275 outpatients and diagnosed constipation and dyspepsia. This study assessed the possible contribution of several sociodemographic, lifestyle, and clinical variables to constipation and dyspepsia using logistic regression analysis. This study also assessed whether these symptoms were associated with abnormal laboratory findings. The prevalence of constipation was 31.3%, and of dyspepsia 23.6%. Paracetamol (OR =3.07, 95% CI =1.34–7.02) and clozapine use (OR =5.48, 95% CI =2.75–10.90), older age (OR =1.04, 95% CI =1.01–1.06), and living in sheltered housing (OR =2.49, 95% CI =1.16–5.33) were risk factors for constipation. For dyspepsia the risk factors were female sex (OR =2.10, 95% CI =1.15–3.83), non-steroidal anti-inflammatory drugs (OR =2.47, 95% CI =1.13–5.39), and diabetes medication (OR =2.42, 95% CI =1.12–5.25). Patients with dyspepsia had lower haemoglobin and haematocrit and higher glucose values than those without dyspepsia. Patients with constipation had lower thrombocyte values than patients without constipation. However, these findings were explained by factors pre-disposing to constipation and dyspepsia. Clozapine use markedly increases the risk of constipation and may lead to life-threatening complications. In addition, analgesics and diabetes medication were related to gastrointestinal symptoms. These medications and their association to gastrointestinal symptoms should be kept in mind when treating patients with schizophrenia.     

Risk factors of respiratory failure in children with Guillain-Barré syndrome

Recently it was found that plasmapheresis and intravenous immunoglobulins are effective in treating patients with Guillain-Barré syndrome (GBS). However, these treatments are expensive and not without possible adverse effects. Because signs and symptoms predictive for respiratory failure in GBS would be helpful in targeting the treatment, risk factors for respiratory failure were evaluated in 120 children with GBS. Twenty children required assisted ventilation. None of the children without any of the following risk factors had respiratory failure. If the symptoms of GBS began within 8 days after a preceding infection, the odds ratio (OR) for respiratory failure was 4.9 [95% confidence intervals (CI): 1.3–18.5]. Cranial nerve involvement was more common in children who required assisted ventilation (15/20 versus 32/100, OR: 6.4, 95% CI: 2.1–19.1). A cerebrospinal protein level >800 mg/L during the first week had an OR for assisted ventilation of 3.1 (95% CI of OR: 1.04–9.0). In the logistic multivariate model, all of these risk factors were associated with the need for assisted ventilation. On the basis of our findings, preventive treatment with either plasmapheresis or intravenous immunoglobulins could be directed to those children with any of the risk factors; for those patients without the risk factors, clinical monitoring would be satisfactory.     

Magnetic resonance imaging white matter hyperintensities and mechanism of ischemic stroke.

BACKGROUND AND PURPOSE: We sought to determine the relations between infarct subtype and white matter hyperintensities (WMHIs) on MRI. MATERIALS AND METHODS: We studied 395 ischemic stroke patients with 1. 0-T MRI. The number of lacunar, border-zone, and cortical infarcts was registered. WMHIs were analyzed in 6 areas. Univariate and multivariate statistical analyses were used to find the risk factors for different infarct subtypes and to study the connections between WMHIs and brain infarcts. RESULTS: Lacunar infarcts were associated with hypertension (odds ratio [OR], 1.79; 95% CI, 1.17 to 2.73), alcohol consumption (OR, 1.96; 95% CI, 1.17 to 3.28), and age (OR, 1. 03; 95% CI, 1.00 to 1.06). Border-zone infarcts were associated with carotid atherosclerosis (OR, 2.20; 95% CI, 1.15 to 4.19). Atrial fibrillation (OR, 3.02; 95% CI, 1.66 to 5.50) and carotid atherosclerosis (OR, 1.94; 95% CI, 1.12 to 3.36) were independent positive predictors, and history of hyperlipidemia (OR, 0.44; 95% CI, 0.26 to 0.75) and migraine (OR, 0.48; 95% CI, 0.25 to 0.93) were negative predictors for cortical infarcts. Patients with lacunar infarcts had more severe WMHIs than patients with nonlacunar infarcts in all WM areas (P相似文献   

The relationship between 24-hour blood pressure readings, subcortical ischemic lesions and vascular dementia

BACKGROUND: Twenty-four-hour blood pressure (BP) readings have been found to correlate with hypertensive target organ damage. Lacunar infarcts (LI) and white matter lesions (WML) probably represent manifestations of cerebral hypertensive target organ damage. This study was conducted to better delineate the relationships between 24-hour BP measurements, LI/WML and small vessel disease cognitive impairment/vascular dementia (CI/VD). METHODS: Two hundred patients with first-time symptomatic LI were examined with 24-hour BP monitoring. The degree of nocturnal BP dip, (daytime BP - nighttime BP)/daytime BP, was categorized into three groups: dippers (>0.1), nondippers (0-0.1) and reverse dippers (<0). WML were subdivided into periventricular hyperintensities (PVH) and subcortical hyperintensities. RESULTS: The breakdown of patients was: 50% nondippers, 27.5% reverse dippers and 22.5% dippers. Forty-one patients (20.5%) were found to have CI and dementia. Male sex (OR 3.35; 95% CI 1.20-9.34), advanced PVH (OR 14.42; 95% CI 5.62-36.98) and absence of a dipping status (nondipper: OR 12.62; 95% CI 1.37-115.95; reverse dipper: OR 11.95; 95% CI 1.27-112.11) were independently associated with CIVD after multivariate analysis. High nighttime systolic BP (OR 3.93; 95% CI 1.38-11.17), high daytime (OR 2.06; 95% CI 1.03-4.04) and nighttime diastolic BP (OR 2.48; 95% CI 1.13-5.45) and absence of a dipping status (nondipper: OR 2.7; 95% CI 1.03-7.05; reverse dipper: OR 3.78; 95% CI 1.38-10.34) were significantly associated with PVH. CONCLUSIONS: High prevalence of a nondipping status was found in the LI cohort. A nondipping status appears to be directly associated with CIVD independent of PVH. This study indicates the need for further studies to investigate whether or not controlling nighttime BP will help reduce the risk for CI/VD development.     

Which dietary and lifestyle behaviours may be important in the aetiology (and prevention) of stroke?

Prevention of stroke requires optimal control of causal risk factors. However, only three-quarters of all strokes can be attributable to known causal risk factors. We aimed to identify novel risk factors for acute stroke in 48 patients with acute (<1 week) stroke admitted to Royal Perth Hospital Stroke Unit and 47 controls matched for age and sex from the northeast Perth metropolitan area. Patients and controls were interviewed, and had physical measurements and blood taken. Multiple odds ratios (OR) for risk factors, with 95% confidence intervals (CI), were calculated by unconditional multiple logistic regression. Mediterranean diet (OR: 0.1; 95% CI, 0.02-0.4), increased waist-to-hip ratio (OR 4.0, 95% CI, 1.5-11), physical activity during leisure time (OR 0.2; 95% CI, 0.1-0.9), periodontal disease (OR 6.4; 95% CI, 1.5-27), and acute febrile illness (OR 14; 95% CI, 1.5-127) were associated significantly and independently with ischaemic stroke. These preliminary data suggest that certain dietary and lifestyle behaviours may play as important a role in the aetiology (and prevention) of stroke as other conventional causal risk factors for stroke. However, these associations need confirmation from larger randomised trials given the small sample size of the current study.