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1.
Pasquale De Bonis Alba Fiorentino Carmelo Anile Mario Balducci Angelo Pompucci Silvia Chiesa Gigliola Sica Gina Lama Giulio Maira Annunziato Mangiola 《Clinical neurology and neurosurgery》2013
Objective
Treatment of glioblastoma recurrence can have a palliative aim, after considering risks and potential benefits. The aim of this study is to verify the impact of surgery and of palliative adjuvant treatments on survival after recurrence.Methods
From January 2002 to June 2008, we treated 76 consecutive patients with recurrent glioblastoma. Treatment was: 1-surgery alone – 17 patients; 2-adjuvant-therapy alone – 24 patients; 3-surgery and adjuvant therapy – 16 patients; no treatment – 19 patients. The impact on median overall-survival (OS-time between recurrence and death/last follow-up) of age, Karnofsky performance scale (KPS), resection extent and adjuvant treatment scheme (Temozolomide alone vs low-dose fractionated radiotherapy vs others) was determined. Survival curves were obtained through the Kaplan–Meier method. Cox proportional-hazards was used for multivariate analyses. Significance was set at p < 0.05.Results
Median OS was 7 months. At univariate analysis, patients with a KPS ≥ 70 had a longer OS (9 months vs 5 months – p < 0.0001). OS was 6 months for patients treated with surgery alone, 5 months for patients that received no treatment, 8 months for patients treated with chemotherapy alone, 14 months for patients treated with surgery and adjuvant therapy-p = 0.01. Patients with a KPS < 70 were significantly at risk for death – HR 2.8 – p = 0.001.Subgroup analysis showed no significant differences between patients receiving gross total or partial tumor resection and among patients receiving different adjuvant therapy schemes. Major surgical morbidity at tumor recurrence occurred in 16 out of 33 patients (48%).Conclusion
It is fundamental, before deciding to operate patients for recurrence, to carefully consider the impact of surgical morbidity on outcome. 相似文献2.
Purpose
To evaluate the efficacy of cyberknife (CK) and neurosurgery (NS) in patients newly diagnosed as solitary brain metastasis (SBM) from non-small cell lung cancer (NSCLC).Methods and materials
We retrospectively analyzed 76 patients between 1990 and 2012 from our institution, including 38 patients performing CK and the other half performing NS. The observation end point was overall survival time (OS), local control of treated metastasis (LC) and intracranial control (IC). Kaplan–Meier OS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS, LC and IC.Results
The baseline characteristic between the two groups was not significantly different. The 1-year OS rates were 53.5% and 30.5% in the CK group and NS group, respectively, (p = 0.121). The 1-year LC rates were 50.8% and 31.3%, respectively, (p = 0.078). The 1-year IC rates were 50.8% and 27.7%, respectively, (p = 0.066). In multivariate analysis, improved OS was significantly associated with younger age (p = 0.016), better ECOG performance status (p = 0.000) and graded prognostic assessment (GPA, 3.5–4.0, p = 0.006). The LC was also associated with better ECOG performance status (p = 0.000). The IC was associated with both better ECOG performance status (p = 0.000) and GPA (3.5–4.0, p = 0.005).Conclusions
There was no statistical difference between CK and NS for SBM from NSCLC in OS, LC and IC. However, CK is less invasive and may be more acceptable for patients. The result needs randomized trials to confirm and further study. 相似文献3.
Benjamin P. Chapman Kevin Fiscella Ichiro Kawachi Paul Duberstein Peter Muennig 《Journal of psychosomatic research》2013
Objective
Suppression of emotion has long been suspected to have a role in health, but empirical work has yielded mixed findings. We examined the association between emotion suppression and all-cause, cardiovascular, and cancer mortality over 12 years of follow-up in a nationally representative US sample.Methods
We used the 2008 General Social Survey–National Death Index (GSS–NDI) cohort, which included an emotion suppression scale administered to 729 people in 1996. Prospective mortality follow up between 1996 and 2008 of 111 deaths (37 by cardiovascular disease, 34 by cancer) was evaluated using Cox proportional hazards models adjusted for age, gender, education, and minority race/ethnicity.Results
The 75th vs. 25th percentile on the emotional suppression score was associated with hazard ratio (HR) of 1.35 (95% Confidence Interval [95% CI] = 1.00, 1.82; P = .049) for all-cause mortality. For cancer and cardiovascular disease mortality, the HRs were 1.70 (95% CI = 1.01, 2.88, P = .049) and 1.47 (95% CI = .87, 2.47, P = .148) respectively.Conclusions
Emotion suppression may convey risk for earlier death, including death from cancer. Further work is needed to better understand the biopsychosocial mechanisms for this risk, as well as the nature of associations between suppression and different forms of mortality. 相似文献4.
Background
Retinal microvascular changes have been previously associated with cerebral MRI markers of small vessel disease (SVD). Whether retinal changes differ between patient with intracerebral haemorrhage (ICH) and patients with lacunar infarction (LI) caused by small vessel disease has been poorly investigated.Objective
The study aims to compare the frequency of retinal changes between patients with LI and patients with ICH at the acute stage of stroke-related SVD.Methods
Microvascular wall signs (arteriolar occlusion, arteriovenous nicking, focal arterial narrowing) and retinopathy lesions (microanevrysms, cotton wool spots, retinal haemorrhages, hard exudates) were assessed by retinography up to three months after stroke onset.Results
Forty-eight non-diabetic patients with acute stroke-related to SVD (26 LI, 22 ICH) were recruited prospectively in the study. Retinal wall signs (arteriovenous nicking, and focal arterial narrowing) were found in more than three quarters of subjects and most often bilaterally in both groups. Retinopathy lesions (cotton wool spots, retinal haemorrhages) were found more frequently in ICH patients than in LI patients (22.2% vs. 15.4%, 50% vs. 34% respectively, P > 0.005). The frequency of bilateral cotton wool spots and of bilateral retinal haemorrhages was significantly higher in ICH patients than in LI patients (12.5% vs. 0%, P = 0.012, 41.2% vs. 7.7%, P = 0.029 respectively).Conclusion
These results confirm the high frequency of microvascular alterations in patients with hypertension-related SVD leading to LI or ICH and suggest that retinal tissue alterations are more frequent in ICH than in LI. Further investigations are needed to investigate the mechanisms underlying this difference. 相似文献5.
Kanika Bagai Candy I. Wakwe Beth Malow Bonnie K. Black Italo Biaggioni Sachin Y. Paranjape Carlos Orozco Satish R. Raj 《Autonomic neuroscience : basic & clinical》2013,177(2):260-265
Study objectives
Patients with postural tachycardia syndrome (POTS) commonly complain of fatigue, unrefreshing sleep, daytime sleepiness and diminished quality of life. The study objective was to assess sleep quality in POTS patients using wrist actigraphy.Design
Prospective study with control group.Methods
Patients with POTS (n = 36) and healthy subjects (n = 36) completed a detailed sleep log and actigraphy for 7 days.Results
Compared with healthy subjects, POTS patients have more self-reported problems including days with restless sleep (53 ± 30% vs. 21 ± 20%; P < 0.001) and tiredness (75 ± 23% vs. 39 ± 27%; P < 0.001). Using actigraphy, POTS patients have lower sleep efficiency (73 ± 13% vs. 79 ± 6%; P = 0.01). Actigraphy determined sleep onset latency (SOL) did not vary significantly in the two groups, but subjective SOL was higher in POTS patient (56 ± 66 min vs. 13 ± 9 min; P = 0.001). In POTS patients, there was a significant correlation between subjective complaints of tiredness and actigraphic sleep efficiency (Rs = − 0.36; R2 = 0.15; P = 0.01), significant correlations between actigraphic SOL and upright norepinephrine levels (P = 0.040), and between wake after sleep onset and standing heart rate (P = 0.02).Conclusions
POTS patients have more sleep-related symptoms and poor sleep efficiency. The pattern of subjective vs. objective SOL mismatch is suggestive of sleep-state misperception. High norepinephrine correlated with actigraphic SOL, and this activation of the stress system may contribute significantly to a hyperarousal state with consequent insomnia, poor mental and physical health in POTS patients. 相似文献6.
Objective
The aim of this study was to compare the characteristics of myasthenic patients with and without thymoma, and the results of thymectomy in both types of patients.Material and methods
A retrospective study was conducted among 66 patients who underwent thymectomy for myasthenia gravis in our department over a 10-year period (2000–2010). The surgical approach was sternotomy or anterolateral thoracotomy. Patients were divided into two groups according to the presence of thymoma: with (T-MG) and without (NT-MG) thymoma. Complete stable remission (CSR) was the primary endpoint.Results
Median age was 35.09 ± 9.89 years. The NT-MG group had 38 patients (57.57%) and the T-MG group 28 patients (42.43%). There was no difference between the two groups regarding the surgical approach (P = 0.52). T-MG patients were older (40.54 ± 15.16 vs. 31.37 ± 9.46) (P = 0.008) and predominantly male. There were more generalized forms (P = 0.01) and more bulbar involvement (P = 0.02) in the T-MG group. The rate of CSR at 5 years was 7% and 17% in the T-MG and NT-MG patients respectively (P = 0.70). At 10 years, it was 36% and 94.73% respectively (P = 0.03).Conclusion
Thymomatous myasthenia gravis is characterized by the severity of its clinical features. Remission rate at 10 years was significantly lower in the myasthenia with thymoma group. 相似文献7.
Peng-Fei Yao Ying Yu Peng-Fei Yang Yi Xu Bo Hong Wen-Yuan Zhao Jian-Min Liu Qing-Hai Huang 《Clinical neurology and neurosurgery》2013
Objectives
Endovascular stents have been widely used in intracranial aneurysm embolization. In this work, we compared the safety and long-term efficacy of stent-assisted coiling with those of conventional coiling for small posterior communicating artery aneurysms, aiming at a better understanding of the related safety and efficacy profiles.Methods
Between January 2008 and December 2011, 114 small PcomA aneurysms (defined as 3 mm ≤ maximum diameter < 10 mm in this study) in 108 patients were treated by endovascular treatment in our department. Patient demographics, aneurysm characteristics, angiographic results (initial and follow-up), and procedural complications were assessed.Results
Embolization was successfully performed in all the patients. Complications occurred in 7.4% of patients in both groups. There was no associated mortality. Based on initial post-procedural angiography, the rate of complete aneurysm occlusion, neck remnant and residual sac in the stented group were 37.9%, 24.1%, and 37.9%, while in the conventional group the figures were 42.9%, 48.2%, and 8.9%, respectively. The initial angiographic results were significantly better in the conventional group, compared with the stented group (P = 0.038). The follow-up results showed that the rate of improvement in the stented group was significantly higher (53.3% vs. 14.0%; P < 0.001) and the recurrence rate was significantly lower than that in the conventional group (4.4% vs. 3.02%; P = 0.001).Conclusion
Compared with conventional coiling, stent-assisted coiling of the small posterior communicating artery aneurysms does not increase the risk. Stents bear an advantage in reducing the recurrence rate, increasing progressive occlusion rate, and improving long-term prognosis in endovascular treatment of intracranial aneurysms. 相似文献8.
Timo Behm Antonia Horowski Simon Schneider Hans Christoph Bock Dorothee Mielke Veit Rohde Florian Stockhammer 《Clinical neurology and neurosurgery》2013
Objective
The effect of concomitant and adjuvant temozolomide in glioblastoma patients above the age of 65 years lacks evidence. However, after combined treatment became standard at our center all patients were considered for combined therapy. We retrospectively analyzed the effect of temozolomide focused on elderly patients.Methods
293 patients with newly diagnosed glioblastoma treated single-centered between 1998 and 2010, by radiation alone or concomitant and adjuvant radiochemotherapy, were included. Treatment groups were analyzed by multi- and univariate analysis. Matched pairs for age, by a 5-year-caliper, extent of resection and general state was generated for all patients and elderly subgroups.Results
103 patients received radiation only and 190 combined treatment. Multivariate and matched pair analysis revealed a benefit due to combined temozolomide (HR 1.895 and 1.752, respectively). For patients older than 65 years median survival was 3.6 (95% CI 3.2–4.7) and 8.7 months (6.3–11.8) for radiotherapy only and combined treatment (HR 3.097, p < 0.0001, n = 90). Over the age of 70 and 75 years median survival was 3.2 (2.3–4.2) vs. 7.5 (5.1–10.9, HR 4.453, p < 0.0001, n = 62) and 3.2 (1.4–3.9) vs. 9.2 months (4.7–13.5; HR 9.037, p < 0.0001, n = 24), respectively. In 8/56 (14%) patients over the age of 70 years temozolomide was terminated due to toxicity.Conclusion
Retrospective matched pair analysis gives class 2b evidence for prolonged survival due to concomitant and adjuvant temozolomide in elderly glioblastoma patients. Until prospective data for combined radiochemotherapy in elderly patients will be available concomitant and adjuvant temozolomide therapy should not be withheld. 相似文献9.
Ting-Ting Low Wei-Zhen Hong Bee-Choo Tai Thet Hein See-Meng Khoo Adeline Y. Tan Mark Y. Chan Mark Richards Chi-Hang Lee 《Sleep medicine》2013,14(10):985-990
Background
We aimed to determine if timing of polysomnography (PSG) influences the diagnosis of obstructive sleep apnea (OSA) in acute myocardial infarction (AMI) or stable coronary artery disease (CAD).Methods
A total of 160 patients admitted with AMI or stable CAD were consecutively recruited for either in-hospital (n = 80) or postdischarge (n = 80) PSG.Results
The median time from admission to PSG for the in-hospital and postdischarge groups was 1 day and 17 days, respectively (P < .001). Overall, 59 patients (36.9%) were diagnosed with OSA (apnea–hypopnea index [AHI] ?15), and they were more likely to have diabetes mellitus (DM), hypertension, hyperlipidemia, chronic renal failure, and a greater body mass index (BMI) (P < .05 for all). The diagnosis of OSA was significantly higher (P = .037) in patients who had a PSG performed as an inpatient than those who had a PSG as an outpatient. There was a significant interaction between clinical presentation and the effect of PSG timing on the diagnosis of OSA (P = .003). For the patients presenting with AMI but not those with stable CAD, in-hospital PSG was an independent predictor of OSA (adjusted odds ratio, 3.84 [95% confidence interval, 1.42–10.41]; P = .008).Conclusion
The timing of PSG influenced the diagnosis of OSA in patients who presented with AMI but not in those who presented with stable CAD. 相似文献10.
Objective
A decompressive hemicraniectomy is a potentially life-saving intervention following head trauma. Once performed patients are obliged to undergo a second procedure with cranioplasty. Two of the most commonly used materials are autologous bone and polymethylmethacrylate (PMMA). We have now evaluated complications following a cranioplasty using these materials.Materials and methods
During a 7-year period (2002–2008) 49 patients were operated with a decompressive craniectomy following head trauma. Patients received a cranioplasty consisting of autologous bone (30 patients, 61.2%) or PMMA (19 patients, 38.8%) and were followed at least 24 months. Patient data were collected retrospectively.Results
Twenty patients (20/49, 40.8%) experienced a complication that prompted a re-operation. There was a significantly higher rate of complications leading to a re-operation (53.3% vs. 21.1%, p = 0.03) and a shorter survival time of the cranioplasty (mean 48.1 ± 7.8 vs. 79.5 ± 9.0 months, p = 0.035) in patients with autologous bone compared to PMMA. Bone resorption and the presence of postoperative hematomas were significantly more common in patients with autologous bone. The material used for cranioplasty was the only variable that significantly correlated to the rate of complications.Conclusions
In our series we had a high percentage of patients needing re-operation due to complications following a cranioplasty. Though generally considered a straightforward procedure, complications and associated morbidity in patients undergoing cranioplasty should not be underestimated. 相似文献11.
Xiao-Nan Liang Li Xie Jian-Wen Cheng Zhen Tan Jun Yao Qian Liu Wei Su Xue Qin Jin-Min Zhao 《Thrombosis research》2013
Background
The polymorphism of the plasminogen activator inhibitor-1 (PAI-1) 4G/5G gene has been correlated with susceptibility to osteonecrosis of the femoral head (ONFH), but study results are controversial. The aim of this study was to derive a more precise estimation of the relationship between the PAI-1 4G/5G Gene polymorphism and ONFH by performing a meta-analysis.Methods
The meta-analysis was based on five eligible case-control studies involving 419 cases and 969 controls and summarized data indicating the association between PAI-1 polymorphism and risk of osteonecrosis of the femoral head. Odds ratios (OR) with 95% confidence intervals (95% CI) were used to assess the strength of this association in the random-effects model or fixed-effects model.Results
A significant association between PAI-1 4G/5G polymorphism and ONFH susceptibility was observed for 4G4G + 4G5G vs. 5G5G (OR = 1.766, 95% CI 1.279–2.437, P = 0.001), 4G/4G vs. 4G/5G + 5G/5G (OR = 2.050, 95% CI 1.581–2.657, P = 0.000), 4G/4G vs. 5G/5G (OR = 2.553, 95% CI 1.345–4.846, P = 0.004), and 4G vs. 5G (OR = 1.758, 95% CI 1.236–2.500, P = 0.002). No significant association between PAI-1 4G/5G polymorphism and ONFH susceptibility was observed for 4G/5G vs. 5G/5G (OR = 1.327, 95% CI 0.939–1.877, P = 0.109).Conclusions
This meta-analysis suggested that 4G/5G polymorphism of the PAI-1 gene was a risk factor for ONFH. This study also suggests that the PAI-1 4G4G genotype may indicate a risk for ONFH. 相似文献12.
Andrea Schulz Mathias Becker Sandra Van der Auwera Sven Barnow Katja Appel Jessie Mahler Carsten Oliver Schmidt Ulrich John Harald J. Freyberger Hans J. Grabe 《Journal of psychosomatic research》2014
Objective
Data suggests that traumatic experiences at early age contribute to the onset of major depressive disorder (MDD) in later life. This study aims at investigating the influence of dispositional resilience on this relationship.Methods
Two thousand and forty-six subjects aged 29–89 (SD = 13.9) from a community based sample who were free of MDD during the last 12 months prior to data collection were diagnosed for Lifetime diagnosis of MDD by the Munich-Composite International Diagnostic Interview (M-CIDI) according to DSM-IV criteria. Childhood maltreatment (CM) and resilience were assessed with the Childhood Trauma Questionnaire (CTQ) and the Resilience-Scale (RS-25).Results
Both CM (OR = 1.03, 95% CI [1.02, 1.04], P < .000) and resilience (OR = 0.98, 95% CI [0.98, 0.99], P < .000) were associated with MDD later in life. The detrimental effects of low resilience on MDD were not only especially prominent in subjects with a history of CM (OR = 3.18, 95% CI [1.84, 5.50], P < .000), but also effective in subjects without CM (OR = 2.62, 95% CI [1.41, 4.88], P = .002).Conclusions
The findings support the clinical assumption that resilient subjects may be partly protected against the detrimental long-term effects of child abuse and neglect. 相似文献13.
Christiane Kugler Christoph Bara Thea von Waldthausen Ina Einhorn Burkhard Haastert Christine Fegbeutel Axel Haverich 《Journal of psychosomatic research》2014
Objective
Depression represents a relevant co-morbidity in patients with chronic heart disease and may diminish the overall success for long-term survival after heart transplantation (HTx). This study aimed to assess the prevalence of depression symptoms in long-term HTx survivors, and to compare depressive patients to those without depression with respect to chronic artery vasculopathy (CAV).Methods
A sample of 203 HTx patients, median 11.5 (IQR 7–17) years after transplant, provided detailed data of depression symptoms, and other psychosocial symptoms including anxiety, family support, professional re-integration, and health-related quality of life (HRQoL). Data were analyzed for an association with CAV.Results
Overall, 14.8% patients (95% CI: 10.2–20.4) showed relevant depression symptoms. No significant differences were seen between non-depressed vs. depressed patients with respect to demographics, clinical variables, and cardiovascular risk factors. Anxiety was prevalent in 9.0% (95% CI: 5.4–13.9) of the sample. Depression symptoms showed impaired HRQoL in the SF-36 physical (P = .012) and psychosocial (P = .0001) components. CAV was prevalent in 34.0% (95% CI: 27.5–41.0), and depression symptoms and CAV were not significantly associated. CAV-patients did not report their physical HRQoL being lower relative to those without CAV (P = .40). Multivariate analysis revealed overweight BMI (OR = 2.20; P = .04), longer time since transplant (OR = 1.10; P = .001), and older age (OR = 1.04; P = .01) being associated with CAV.Conclusion
Depression symptoms are prevalent in long-term survivors after HTx, and psychological impairments decrease patients' perceptions of HRQoL. More research seems necessary to identify the inter-relationship between depression symptoms and CAV, in order to develop targeted interventions to overcome this problem. 相似文献14.
Objectives
To evaluate the role of filter implantation in reducing the incidence of fatal pulmonary embolism during the endovascular treatment of thrombosis in the major tributary of the superior vena cava (SVC).Methods
From October 2004 to October 2008, we conducted a cohort study of 40 patients with thrombosis of the central veins who were preparing for endovascular interventions and received or did not receive filter. The symptom scores were measured, the incidence of pulmonary embolism (PE) was observed, and patient follow-up studies were conducted for three years.Results
One week after therapy, the symptom score improved in both groups compared with before therapy (P < 0.001), but no significant difference was found between the scores of the two groups (P > 0.05). Four patients in the control group died from PEs after therapy, but no patients in the filter group presented evidence of PE. The survival rates at 1, 2, and 3 years (72.9%, 50%, and 27.1%, respectively) for the filter group were higher than those for the control group (47.6%, 19.0% and 14.3%, respectively; P = 0.015). The survival time of patients in the filter group with bronchogenic carcinoma (18 ± 2 months) was longer than that of the patients in the control group (12 ± 2 months) after the endovascular treatment (P < 0.001).Conclusions
Prophylactic filter placement could be a safe and effective method for preventing PE in pre- or post-endovascular-treated patients with thrombi in their central veins. 相似文献15.
P. Sobolewski G. Kozera R. Kaźmierski S. Michalak W. Szczuchniak M. Śledzińska-Dźwigał W.M. Nyka 《Clinical neurology and neurosurgery》2013
Objective
Renal dysfunction (RD) increases risk for ischaemic stroke (IS). The impact of RD on the effects of iv-thrombolysis in the Caucasian population has not been fully determined.Aims
To evaluate the associations between RD and the outcome of iv-thrombolysis in Caucasian patients with IS.Methods
The observational, multicentre study included 404 patients with IS who were treated with iv-thrombolysis. RD was defined as estimated glomerular filtration rate ≤60 ml/min/1.73 m2. Outcome was assessed with modified Rankin Score at 3 months after the stroke onset.Results
Medians baseline NIHSS score did not differ between groups of patients with and without RD (12.0 vs. 11.0 pts, p = 0.33). Unfavourable outcome was found in 52.1% of patients with and in 41.2% of patients without RD (p = 0.05), mortality was higher in patients with RD (29.9% vs. 14.3%, p < 0.001), and the presence of haemorrhagic transformation (HT) did not differ between the groups (17.1% vs. 17.1% respectively, p = 0.996). A multivariate analysis showed no impact of RD on the unfavourable outcome (OR 0.98; 95%CI 0.88–1.10), mortality (OR 0.92; 95%CI 0.81–1.05) or presence of HT (OR 1.03; 95%CI 0.90–1.18).Conclusions
We found no impact of RD on the safety and efficacy of iv-thrombolysis in Caucasian patients with IS. 相似文献16.
Dorothea Miller Valeria Zappala Nicolai El Hindy Elisabeth Livingstone Dirk Schadendorf Ulrich Sure Ibrahim Erol Sandalcioglu 《Clinical neurology and neurosurgery》2013
Introduction
Brain metastases (BM) commonly occur in patients with metastatic malignant melanoma (MM). Prognosis is poor even with maximal therapy. The aim of the current study was to retrospectively evaluate patients with BM of MM who were treated neurosurgically with respect to clinical presentation, recurrent disease, survival and factors affecting survival.Patients and methods
Thirty-four patients (19 f/15 m) with BM of MM were treated in our hospital between 2000 and 2010. Patient data were analysed, survival was examined using Kaplan–Meier-estimates and factors affecting prognosis were evaluated using uni- and multivariate analysis.Results
Twenty-two patients (64.7%) had a single BM, whereas twelve patients (35.3%) revealed two or more lesions. Median survival for patients with a single BM was 13.0 months (95%-CI 9.3–16.7 months), this was significantly (p = 0.014) better than for patients with two or more BM (median 5.0, 95%-CI 3.4–14.6 months).Nineteen patients (55.9%) developed an intracranial relapse after microsurgical resection of a first lesion. Patients with an isolated intracerebral relapse survived significantly (p = 0.003) longer than those with systemic progression (median 6.0, 95%-CI 0.0–15.3 months vs median 3.0, 95%-CI 1.7–4.3 months). Similarly, patients with a high performance status showed significantly (p = 0.001) prolonged survival (median 7.0, 95%-CI 0.0–19.9 months vs median 1.0, 95%-CI 0.0–2.2 months). Eleven out of nineteen patients (57.9%) underwent either another microsurgical resection (n = 6) or stereotactic radiosurgery (n = 5). These patients remained on a high performance status even after aggressive therapy.Discussion
Even though the prognosis for patients with BM of MM is generally poor, patients with a single BM can benefit from microsurgical resection. However, there is a high risk of intracranial relapse. In selected patients with a good performance status and recurrent intracranial disease, recurrent local therapy can be justified and useful. 相似文献17.
R. Loeffen R. van Oerle P.G. de Groot J. Waltenberger H.J. Crijns H.M.H. Spronk H. ten Cate 《Thrombosis research》2014
Objective
One of the contributing mechanisms in acute myocardial infarction (AMI) is plasma hypercoagulability. Recently, it was suggested that factor XI activation might play a role in atherothrombosis. To quantify factor XIa plasma levels, we developed a new thrombin generation based assay and hypothesized that in AMI patients factor XIa levels are increased during the acute thrombotic event.Methods
A prospective cohort study was performed including 56 patients with first AMI. Blood was collected upon admission and after 6 months. Reference blood samples were obtained from 30 apparently healthy control subjects. Plasma samples were diluted (1:5) in factor XI deficient plasma and factor XIa plasma levels were established using a reference curve (0-12.5 pM factor XIa) and an inhibitory anti-factor XIa antibody. The established FXIa concentrations were related to the 1-year outcome.Results
Factor XIa plasma concentrations were significantly increased in AMI patients on admission compared to 6 months after the event (3.7 pM [2.7-5.5] vs. 2.8 [1.9-4.3], median ± IQR; P = 0.001) and compared to healthy controls (3.7 pM [2.7-5.5] vs. 2.7 [1.6-4.2], median ± IQR; P = 0.004). However, a high factor FXIa level at baseline was not significantly associated with a recurrent cardiovascular event (OR 1.26, 95%CI 0.33-4.7).Conclusions
This study presents the first application of a new thrombin generation based factor XIa assay, showing significantly increased factor XIa levels in AMI patients on admission compared to 6 months after the event and compared to healthy controls. The factor XIa concentration was not associated with the risk of recurrence. 相似文献18.
Bert Bosche Marek Molcanyi Thomas Noll Matthias Kochanek Bastian Kraus Bernhard Rieger Faycal El Majdoub Christian Dohmen Mario Löhr Roland Goldbrunner Gerrit Brinker 《Clinical neurology and neurosurgery》2013
Objective
In some patients, chronic subdural haematoma (cSDH) appears to occur spontaneously with frequent re-bleeding events. The pathophysiology of this phenomenon is still poorly understood. Because coagulation factor XIII (FXIII) is known to be involved in vascular integrity, endothelial barrier function and wound healing, we evaluated the role of FXIII in spontaneous cSDH.Methods
We prospectively scrutinised the origin of cSDH in 117 patients and identified a subgroup of patients suffering from spontaneous cSDH who were included in this study. We analysed the plasma activity of FXIII and standard coagulation parameters and compared these data to age- and sex-matched healthy controls. We assessed the occurrence of re-bleeding events using clinical and imaging data and compared FXIII activity in patients with and without re-bleeding events.Results
Out of 117 cSDH patients, 18 individuals suffered from spontaneous cSDH in this study. The patients with spontaneous cSDH showed significantly lower FXIII activity than the control group (65% [52.75, 80.25] (median [IQR]) vs. 93% [81, 111], P = 0.001), whereas standard coagulation parameters did not differ significantly between the groups. Six patients developed re-bleeding events after haematoma evacuation, and these patients expressed significantly lower FXIII activity compared to the other 12 patients (47.5% [33.5, 64] vs. 78.5% [58, 87], P = 0.005). The patient group with FXIII ≤ 68.5% differed significantly from the group with FXIII > 68.5% when categorised by the occurrence of re-bleeding events (n = 6/9 vs. n = 0/9, P = 0.009). This cut-off value predicted the re-bleeding events with a sensitivity of 100% and a specificity of 75% (positive predictive value: 66%, negative predictive value: 100%).Conclusion
FXIII deficiency may play a pathophysiological role in spontaneous cSDH, so we suggest investigating FXIII activity because it may predict re-bleeding events after treatment. In individuals with considerably low FXIII activity, FXIII substitution may mitigate the chronic nature of this disease. 相似文献19.
Aysegul Demirel Omer Faruk DemirelMurat Emül Alaattin DuranMufit Uğur 《Comprehensive psychiatry》2014
Objectives
The use of atypical antipsychotic drugs in patients with psychiatric illness may result in dyslipidemia, hypertension, glucose intolerance, and abdominal obesity, which are together referred to as metabolic syndrome (MS). To investigate any correlations among insulin-like growth factor-1 (IGF-1), schizophrenia, and MS, we examined the metabolic profiles of patients with schizophrenia taking atypical antipsychotics.Design
Patients with schizophrenia, their siblings, and controls participated in this study (N = 50 in each group). The Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID I) and the Brief Psychiatric Rating Scale (BPRS) were administered to patients, and SCID I was administered to patients' siblings. We drew blood to measure IGF-1 levels and to determine the metabolic profiles of all participants; we also conducted anthropometric measurements.Results
There were no significant differences in IGF-1 levels between groups. By comparing IGF-1 levels with MS-related parameters, we found that IGF-1 levels were negatively correlated with triglyceride levels in the control group, and positively correlated with HDL levels in the patient group (Pearson's correlation: r = −0.291, P = 0.04, and r = 0.328, P = 0.02, respectively). Compared to their siblings, patients with schizophrenia had a significantly different body mass index, waist circumference, and insulin resistance, and showed a trend toward a difference in glucose levels (ANOVA: P = 0.004, P < 0.0001, P = 0.004, P = 0.072, respectively).Conclusion
A correlation between IGF-1 and MS may significantly influence future therapeutic strategies for MS. In order to determine the role of IGF-1 in schizophrenia, comprehensive longitudinal studies with first-episode drug-naive patients are needed. 相似文献20.
Erhan Turkoglu Bora GurerAhmet M. Sanli Habibullah DolgunLevent Gurses Nezih A. OralTeoman Donmez Zeki Sekerci 《Clinical neurology and neurosurgery》2013